| Dr Wallace Scott Johnson, OD | |
|
775 Buckskin Ave W, Pillager, MN 56473-2509 | |
| (218) 746-2020 | |
| (218) 520-0654 |
| Full Name | Dr Wallace Scott Johnson |
|---|---|
| Gender | Male |
| Speciality | Optometry |
| Experience | 37 Years |
| Location | 775 Buckskin Ave W, Pillager, Minnesota |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346209020 | NPI | - | NPPES |
| 63372 | Other | MN | MPIN |
| 970525200 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152WC0802X | Optometrist - Corneal And Contact Management | 2196 (Minnesota) | Secondary |
| 152W00000X | Optometrist | 2196 (Minnesota) | Primary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Up North Eye Care Pa | 6709208887 | 2 |
| Provider Name | Up North Eye Care Pa |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1497389944 PECOS PAC ID: 6709208887 Enrollment ID: O20200619000565 |
| Provider Name | Worthington Eye Clinic, Llc |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1306452131 PECOS PAC ID: 9830501923 Enrollment ID: O20201214002861 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Wallace Scott Johnson, OD 775 Buckskin Ave W Ste 1, Pillager, MN 56473-2509 Ph: (218) 746-2020 | Dr Wallace Scott Johnson, OD 775 Buckskin Ave W, Pillager, MN 56473-2509 Ph: (218) 746-2020 |
Stephanie Parrish, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 649 Pillsbury St N, Pillager, MN 56473 Phone: 218-746-2020 | |
Up North Eye Care, P.a. Optometrist Medicare: Medicare Enrolled Practice Location: 775 Buckskin Ave W Ste 1, Pillager, MN 56473 Phone: 218-746-2020 Fax: 218-520-0654 |