Provider Demographics
NPI:1508042417
Name:KATHERINE E JOHNSON, MD PC
Entity Type:Organization
Organization Name:KATHERINE E JOHNSON, MD PC
Other - Org Name:MOUNTAIN VIEW EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-328-2910
Mailing Address - Street 1:2555 PHILLIPS FIELD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3933
Mailing Address - Country:US
Mailing Address - Phone:907-328-2920
Mailing Address - Fax:
Practice Address - Street 1:2555 PHILLIPS FIELD RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3933
Practice Address - Country:US
Practice Address - Phone:907-328-2920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6104207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1021226Medicaid
AK1891999272OtherNPI
1508042417OtherGROUP NPI