Healthcare Provider Details

I. General information

NPI: 1932487493
Provider Name (Legal Business Name): DANAE ADRIANNE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANAE ADRIANNE JOHNSON O.D.

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 SUGAR MAPLE DR
WPAFB OH
45433-5529
US

IV. Provider business mailing address

4881 SUGAR MAPLE DR
WPAFB OH
45433-5529
US

V. Phone/Fax

Practice location:
  • Phone: 813-827-9130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number4901004769
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004769
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: