Provider Demographics
NPI:1538157607
Name:JOHNSON, JILL B (MD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:B
Last Name:JOHNSON
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Gender:F
Credentials:MD
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Mailing Address - Street 1:3601 W 76TH ST
Mailing Address - Street 2:STE 300
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-3004
Mailing Address - Country:US
Mailing Address - Phone:952-897-1175
Mailing Address - Fax:952-897-1178
Practice Address - Street 1:7760 FRANCE AVE S
Practice Address - Street 2:SUITE 310
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55435-5800
Practice Address - Country:US
Practice Address - Phone:952-897-1175
Practice Address - Fax:952-897-1178
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2020-08-20
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Provider Licenses
StateLicense IDTaxonomies
MN35138207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31782200Medicaid
MN227095100Medicaid
WI31782200Medicaid
MN227095100Medicaid