Dr. Brent Bundy Johnson, OD
Optometrist in Madison, NC. Individual provider (NPI-1).
NPI number1235239641
StatusActive
Last updated in NPPESOct 26, 2023
Details
- NPI
- 1235239641
- Entity type
- Individual (NPI-1)
- Name
- Dr. Brent Bundy Johnson
- Credential
- OD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Sep 25, 2006
- Certification date
- Oct 26, 2023
- Last updated
- Oct 26, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | 1830 | NC | Yes |
| 152W00000X | Optometrist | OET 008758 | PA | |
| 152W00000X | Optometrist | TUV 006646 | NY |
Practice location
714 Highway StMadison, NC 27025-1508
Phone 336-427-2020 · Fax 336-427-2022
Mailing address
5783 East Lake RdRomulus, NY 14541
Phone 315-283-8928
Other practice locations
830 County Rt. 64
Wal-Mart Vision Center # 1976
Elmira, NY 14903
Wal-Mart Vision Center # 1976
Elmira, NY 14903
Phone 607-739-5209 · Fax 607-739-5370
3354 W Friendly Ave
Greensboro, NC 27410-4888
Greensboro, NC 27410-4888
Phone 336-387-0930
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