MEDICARE: DR. KEVIN LEE 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	152WC0802X	Corneal and Contact Management Optometrist	2419	TN
2	152WC0802X	Corneal and Contact Management Optometrist	1786	CO

General Provider Information

NPI Number	:	1538215777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN LEE JOHNSON O.D.

Provider Business Mailing Address
First Line	:	1016 GOLF CLUB CT
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-8885
Country	:	US
Telephone Number	:	615-497-5512
Fax Number	:

Provider Business Practice Location Address
First Line	:	2021 CHURCH ST STE 300
Second Line	:	BAPTIST HOSPITAL, MEDICAL PLAZA 2
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2051
Country	:	US
Telephone Number	:	615-340-4733
Fax Number	:

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

Provider Enumeration Date	:	01/27/2007
Last Update Date	:	09/19/2012

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