Provider Demographics
NPI:1386227338
Name:JOHNSON, KYLEE ARNETT (OD)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:ARNETT
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 1:2351 FINNERTY RD
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-9436
Mailing Address - Country:US
Mailing Address - Phone:989-709-6426
Mailing Address - Fax:
Practice Address - Street 1:304 W HOUGHTON AVE
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-1222
Practice Address - Country:US
Practice Address - Phone:989-345-2020
Practice Address - Fax:989-345-1281
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005534152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist