MEDICARE: KODY JOHNSON

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	6974	FL

General Provider Information

NPI Number	:	1437012671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KODY JOHNSON

Provider Business Mailing Address
First Line	:	1185 S PINELLAS AVE APT 5203
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-3761
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9624 US HIGHWAY 19
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-4642
Country	:	US
Telephone Number	:	727-232-2949
Fax Number	:

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

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	06/08/2026

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Directions to “ KODY JOHNSON ” Practice Location

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