Johnson, Bruce L
Johnson, Bruce L is an individual health care provider with primary practice located at 1008 Riverburch Pkwy , Dalton GA 30721-8630. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Johnson, Bruce L can be contacted via phone (706) 278-0518.Contact Information
Primary practice address
1008 Riverburch Pkwy
Dalton GA 30721-8630
Phone: (706) 278-0518
Fax: (706) 275-9715
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Eye and Vision Services Providers / Optometrist | 152W00000X | OPT001333 | Georgia |
Profile Details
NPI number | 1710919634 |
---|---|
LBN Legal business name | Johnson, Bruce L |
Credentials | Doctor of Optometry (OD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Jul 7th, 2006 |
Last updated | Mar 29th, 2011 - about 14 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1710919634 | NPPES |
Georgia | MEDICAID | 00514962A | |
Georgia | Other | OPT001333 |
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