Provider Demographics
NPI:1376900555
Name:JOHNSON, MARIANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:
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 1:129 E CLARK BLVD
Mailing Address - Street 2:APT 28303
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2112
Mailing Address - Country:US
Mailing Address - Phone:615-893-8847
Mailing Address - Fax:
Practice Address - Street 1:1801 W END AVE STE 1150
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2528
Practice Address - Country:US
Practice Address - Phone:615-321-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2001DT152W00000X
TNTN3297152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist