Johnson, Ansel T

Johnson, Ansel T is an sole proprietor health care provider with primary practice located at 12812 Western Ave , Blue Island IL 60406-2118. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Johnson, Ansel T can be contacted via phone (708) 385-0013.

Contact Information

Primary practice address
12812 Western Ave Blue Island IL 60406-2118
Phone: (708) 385-0013
Fax: (708) 385-1175
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 046007826 Illinois

Profile Details

NPI number 1023106309
LBN Legal business name Johnson, Ansel T
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 11th, 2006
Last updated Sep 21st, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023106309 NPPES
Illinois Other 1636075 BCBSIL ID
Illinois MEDICAID 046007826 BCBSIL ID
Illinois Other 0718670001 BCBSIL ID
Illinois Other 363718601 BCBSIL ID
Illinois Other 410011831 BCBSIL ID

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