Provider Demographics
NPI:1366413072
Name:JOHNSON, STEVEN G (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:G
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:HORTON
Mailing Address - State:MI
Mailing Address - Zip Code:49246-9756
Mailing Address - Country:US
Mailing Address - Phone:517-688-9494
Mailing Address - Fax:
Practice Address - Street 1:817 W GANSON ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-4202
Practice Address - Country:US
Practice Address - Phone:517-782-4300
Practice Address - Fax:517-782-4708
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003631152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist