Provider Demographics
NPI:1568740157
Name:JOHNSON, REBECCA APRIL (OD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:APRIL
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 1:7121 STANDIFORD ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-3886
Mailing Address - Country:US
Mailing Address - Phone:989-640-4236
Mailing Address - Fax:
Practice Address - Street 1:7121 STANDIFORD ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-3886
Practice Address - Country:US
Practice Address - Phone:989-640-4236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004647152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist