Provider Demographics
NPI:1073597670
Name:JOHNSON, ANGELA P (OD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:P
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 ROCK SPRINGS MIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANA
Mailing Address - State:TN
Mailing Address - Zip Code:37037-5357
Mailing Address - Country:US
Mailing Address - Phone:615-203-9098
Mailing Address - Fax:
Practice Address - Street 1:1524 BEASIE RD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-2945
Practice Address - Country:US
Practice Address - Phone:615-439-2646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1993152W00000X
MN2955152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN410002518Medicare PIN
U79710Medicare UPIN