Provider Demographics
NPI:1386883254
Name:JOHNSON, JAMES EDWARD
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 5TH ST E STE 281
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1862
Mailing Address - Country:US
Mailing Address - Phone:651-227-6506
Mailing Address - Fax:651-288-4740
Practice Address - Street 1:101 5TH ST E STE 281
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1862
Practice Address - Country:US
Practice Address - Phone:651-227-6506
Practice Address - Fax:651-288-4740
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician