MEDICARE: DR. TAMMY 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	OPC5464	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	OPC5464	OTHER	FL	STATE LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407973175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAMMY JOHNSON O.D.

Provider Business Mailing Address
First Line	:	9617 GULF RESEARCH LN
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4560
Country	:	US
Telephone Number	:	239-418-0999
Fax Number	:	239-418-0091

Provider Business Practice Location Address
First Line	:	2301 DEL PRADO BLVD S STE 630
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-6623
Country	:	US
Telephone Number	:	239-542-4123
Fax Number	:

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	03/06/2026

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