=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932279288
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KATHERINE H. JOHNSON OD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3000 S HORNER BLVD
-----------------------------------------------------
City | SANFORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27332-9644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-774-3310
-----------------------------------------------------
Fax | 919-774-4950
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5149 LINKSLAND DR
-----------------------------------------------------
City | HOLLY SPRINGS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27540-9155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-557-0957
-----------------------------------------------------
Fax | 919-774-4950
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. KATHERINE HOOD JOHNSON
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 919-774-3310
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1367
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------