MEDICARE: KATHLEEN ANN JOHNSON O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TUV007279-01	NY
2	152W00000X	Optometrist	TUV007279	NY

General Provider Information

NPI Number	:	1043472327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN ANN JOHNSON O.D.

Provider Business Mailing Address
First Line	:	320 HEMPSTEAD AVE
Second Line	:
City	:	WEST HEMPSTEAD
State	:	NY
Zip	:	11552-2043
Country	:	US
Telephone Number	:	516-565-2616
Fax Number	:	516-481-1953

Provider Business Practice Location Address
First Line	:	320 HEMPSTEAD AVE
Second Line	:
City	:	W HEMPSTEAD
State	:	NY
Zip	:	11552-2043
Country	:	US
Telephone Number	:	516-565-2616
Fax Number	:	516-481-1953

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2008
Last Update Date	:	12/08/2020

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