Active Life Eye Care, Od, PA

NPI #1740663855 in Madison, North Carolina

Provider Information

NPI Number: 1740663855
Entity Type: Organization
Organization Name: Active Life Eye Care, Od, PA
Primary Specialty: Optometrist
Enumeration Date: Jul 7, 2015
Last Updated: Jan 11, 2016

Practice Location

Address: 415 W ACADEMY ST
City: Madison
State: North Carolina
ZIP Code: 27025-2005
Phone: (336) 404-6235

Authorized Official

Name: DR. BRENT B. JOHNSON, O.D.
Title: OPTOMETRIST
Phone: (336) 404-6235

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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