Healthcare Provider Details

I. General information

NPI: 1083822696
Provider Name (Legal Business Name): CATHERINE ANNE JOHNSON O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W HOLLIS ST STE 109
NASHUA NH
03062-1386
US

IV. Provider business mailing address

940 COMMONWEALTH AVE SUITE NEW ENGLAND EYE INSTITUTE
BOSTON MA
02215
US

V. Phone/Fax

Practice location:
  • Phone: 603-882-0311
  • Fax:
Mailing address:
  • Phone: 617-587-5511
  • Fax: 617-587-5512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number1098
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4575
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: