Provider Demographics
NPI:1346928751
Name:JOHNSON, VICTORIA JO (OD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:JO
Last Name:JOHNSON
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 ARNOLD PALMER LN
Mailing Address - Street 2:
Mailing Address - City:ELK POINT
Mailing Address - State:SD
Mailing Address - Zip Code:57025-2313
Mailing Address - Country:US
Mailing Address - Phone:605-670-0578
Mailing Address - Fax:
Practice Address - Street 1:11 SHRINER ST
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-1155
Practice Address - Country:US
Practice Address - Phone:605-624-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA130794152W00000X
GAOPT003533152W00000X
MN3966152W00000X
SD823152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist