Johnson, Wallace Scott
Johnson, Wallace Scott is an individual health care provider with primary practice located at 702 10Th St , Worthington MN 56187-2767. He recently has 2 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Eye and Vision Services Providers / Corneal and Contact Management. Eye and Vision Services Providers / Optometrist is his primary health care specialty. Johnson, Wallace Scott can be contacted via phone (507) 376-5535.Contact Information
Primary practice address
702 10Th St
Worthington MN 56187-2767
Phone: (507) 376-5535
Fax: (507) 376-4805
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 2196 | Minnesota |
| Eye and Vision Services Providers / Corneal and Contact Management | 152WC0802X | 2196 | Minnesota |
Profile Details
| NPI number | 1346209020 |
|---|---|
| LBN Legal business name | Johnson, Wallace Scott |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 21st, 2006 |
| Last updated | Mar 3rd, 2015 - about 9 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 | 1346209020 | NPPES |
| Minnesota | Other | 63372 | MPIN |
| Minnesota | MEDICAID | 970525200 | MPIN |
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