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General NPI Number Information
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NPI Number | 1073826608
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Entity Type | Individual
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Provider Name | KATIE LEA JOHNSON O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/25/2010
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Last Update Date | 03/09/2011
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Provider Practice Location Address
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Address Line | 424 N UNIVERSITY AVE STE 5AND6
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City | LITTLE ROCK
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State | AR
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Zip | 72205-3109
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Country | US
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Telephone | 501-663-1131
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Fax |
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Provider Business Mailing Address
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Address Line | 9401 JOHNSON RD
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City | MABELVALE
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State | AR
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Zip | 72103-2951
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2651
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License Number State | AR
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