Johnson, Ansel T
Johnson, Ansel T is an sole proprietor health care provider with primary practice located at 12812 Western Ave , Blue Island IL 60406-2118. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Johnson, Ansel T can be contacted via phone (708) 385-0013.Contact Information
Primary practice address
12812 Western Ave
Blue Island IL 60406-2118
Phone: (708) 385-0013
Fax: (708) 385-1175
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 046007826 | Illinois |
Profile Details
| NPI number | 1023106309 |
|---|---|
| LBN Legal business name | Johnson, Ansel T |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 11th, 2006 |
| Last updated | Sep 21st, 2020 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1023106309 | NPPES |
| Illinois | Other | 1636075 | BCBSIL ID |
| Illinois | MEDICAID | 046007826 | BCBSIL ID |
| Illinois | Other | 0718670001 | BCBSIL ID |
| Illinois | Other | 363718601 | BCBSIL ID |
| Illinois | Other | 410011831 | BCBSIL ID |
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