Provider Demographics
NPI:1467494492
Name:JOHNSON, DAWN L (OD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:L
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:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:COALING
Mailing Address - State:AL
Mailing Address - Zip Code:35449-0052
Mailing Address - Country:US
Mailing Address - Phone:205-796-5125
Mailing Address - Fax:
Practice Address - Street 1:1701 MCFARLAND BLVD E
Practice Address - Street 2:141
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-5824
Practice Address - Country:US
Practice Address - Phone:205-556-0701
Practice Address - Fax:205-556-0701
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR147TA686152W00000X
IN18002717B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU54913Medicare UPIN