NPI 1235430216

Gary E. Johnson, O.D., P.C.

Organisation Exclusive Provider Organization Fargo, ND

Practice location

Address: 3757 55th Ave S, Fargo, ND 58104-6365
Phone: (701) 356-1717
Fax: (701) 356-1718

Authorised official

Name: Gary Elijah Johnson
Title: President
Phone: (701) 640-8773

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence 607 (ND)

Other Exclusive Provider Organization providers in North Dakota →

Registry record

NPI: 1235430216
Entity type: Organization
NPI issued: 8 Nov 2010
Record last updated: 11 Jan 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.