Healthcare Provider Details

I. General information

NPI: 1396476727
Provider Name (Legal Business Name): SOPHIA ELIZABETH GRABIEL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOPHIA ELIZABETH JOHNSON O.D.

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 E CHISHOLM ST STE A
ALPENA MI
49707-2862
US

IV. Provider business mailing address

8614 WESTWOOD CENTER DR FL 9
VIENNA VA
22182-2442
US

V. Phone/Fax

Practice location:
  • Phone: 989-354-5890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901005641
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: