Healthcare Provider Details

I. General information

NPI: 1407788607
Provider Name (Legal Business Name): ALYSSA SELINE JOHNSON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1658 NE MIAMI GARDENS DR
MIAMI FL
33179-4900
US

IV. Provider business mailing address

651 NW 82ND AVE APT 621
PLANTATION FL
33324-1509
US

V. Phone/Fax

Practice location:
  • Phone: 305-949-4221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC6968
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: