person
Kenneth N Johnson
Optician in Niantic, Connecticut
NPI 1710580436

Kenneth N Johnson is a Optician based in Niantic, CT and is specialized in Optician. Kenneth N Johnson practices in Niantic, CT. The NPI Number for Kenneth N Johnson is 1710580436 and holds a License No. CT0001217 (Connecticut).

The current practice location address for Kenneth N Johnson is 179 Flanders Rd, Niantic, CT and can be reached out via phone at 860-691-0279.

Location: 179 Flanders Rd, Niantic, CT, 06357-1206
person
Provider Profile Details
NPI Number
1710580436
Provider Name
Kenneth N Johnson
Credential
Provider Entity Type
Individual
Gender
Male
Address
179 Flanders Rd, Niantic, CT, 06357-1206
Phone Number
860-691-0279
Fax Number
Provider Enumeration Date
11/17/2020
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1326280512 05 CT
0001217 05 CT
institution
Provider Business Practice Location Address Details
Address
179 Flanders Rd
City
State
Zip
06357-1206
Phone Number
860-691-0279
Fax Number
person
Provider Business Mailing Address Details
Address
179 Flanders Rd
City
State
Zip
06357-1206
Phone Number
860-691-0279
Fax Number
person
Provider's Taxonomy Details 1
Type
Eye and Vision Services Providers
Classification
Technician/Technologist
Speciality
Optician
Taxonomy
License No.
CT0001217 (Connecticut)
Definition
Definition to come...
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