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General NPI Number Information
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NPI Number | 1467673814
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Entity Type | Individual
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Provider Name | STEPHANIE L JOHNSON O.D.
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Gender | Female
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 464016 STATE ROAD 200
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City | YULEE
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State | FL
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Zip | 32097-6339
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Country | US
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Telephone | 904-504-3953
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Fax | 904-261-8330
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Provider Business Mailing Address
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Address Line | 96166 DOWLING DR
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City | YULEE
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State | FL
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Zip | 32097-6317
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Country | US
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Telephone | 904-237-7997
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Fax | 904-503-2615
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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 | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | OPC 2964
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC2964
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License Number State | FL
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