Healthcare Provider Details

I. General information

NPI: 1407887755
Provider Name (Legal Business Name): KIMBERLY A JOHNSON O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 AVENUE D STE 102B
GOTHENBURG NE
69138-1955
US

IV. Provider business mailing address

1214 COUNTRYSIDE LN
GOTHENBURG NE
69138-2500
US

V. Phone/Fax

Practice location:
  • Phone: 308-537-2020
  • Fax: 308-537-2280
Mailing address:
  • Phone: 308-537-3166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1232
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1232
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number1232
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number1232
License Number StateNE
# 5
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number1232
License Number StateNE
# 6
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number1232
License Number StateNE
# 7
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number1232
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: