Johnson, Kenneth N

Johnson, Kenneth N is an individual health care provider with primary practice located at 179 Flanders Rd , Niantic CT 06357-1206. He recently has only one registered license in Eye and Vision Services Providers / Optician, which is considered as his primary health care specialty. Johnson, Kenneth N can be contacted via phone (860) 691-0279.

Contact Information

Primary practice address
179 Flanders Rd Niantic CT 06357-1206
Phone: (860) 691-0279
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optician 156FX1800X CT0001217 Connecticut

Profile Details

NPI number 1710580436
LBN Legal business name Johnson, Kenneth N
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 17th, 2020
Last updated Nov 17th, 2020 - about 4 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 1710580436 NPPES
Connecticut MEDICAID 1326280512
Connecticut MEDICAID 0001217

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