person
Jerel Dean Johnson, ABOCOPTICIAN
Optician in Cook, Minnesota
NPI 1750421160

Jerel Dean Johnson is a Optician based in Cook, MN and is specialized in Optician. Jerel Dean Johnson practices in Cook, MN and has the professional credentials of ABOCOPTICIAN. The NPI Number for Jerel Dean Johnson is 1750421160 and holds a License No. 19618 (Minnesota).

The current practice location address for Jerel Dean Johnson is 23 East Vermilion Ave, Cook, MN and can be reached out via phone at 218-666-2879.

Location: 23 East Vermilion Ave, Cook, MN, 55723-0127
person
Provider Profile Details
NPI Number
1750421160
Provider Name
Jerel Dean Johnson
Credential
ABOCOPTICIAN
Provider Entity Type
Individual
Gender
Male
Address
23 East Vermilion Ave, Cook, MN, 55723-0127
Phone Number
218-666-2879
Fax Number
Provider Enumeration Date
02/07/2007
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
66791CO 01 MN 1ST PLAN BLUE
110191 01 MN UCARE
2100594 01 MN MEDICA
66791CO 01 MN BCBS
institution
Provider Business Practice Location Address Details
Address
23 East Vermilion Ave
City
State
Zip
55723-0127
Phone Number
218-666-2879
Fax Number
person
Provider Business Mailing Address Details
Address
23 East Vermilion Ave
City
State
Zip
55723-0127
Phone Number
218-666-2879
Fax Number
person
Provider's Taxonomy Details 1
Type
Eye and Vision Services Providers
Classification
Technician/Technologist
Speciality
Optician
Taxonomy
License No.
19618 (Minnesota)
Definition
Definition to come...
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