Provider Demographics
NPI:1649584053
Name:JOHNSON, LOUISA C GAITER (OD)
Entity Type:Individual
Prefix:
First Name:LOUISA
Middle Name:C GAITER
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 1:1568 WOODBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19057-1508
Mailing Address - Country:US
Mailing Address - Phone:215-943-7800
Mailing Address - Fax:215-943-6254
Practice Address - Street 1:1568 WOODBOURNE RD
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19057-1508
Practice Address - Country:US
Practice Address - Phone:215-943-7800
Practice Address - Fax:215-943-6254
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002343152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOEG002343OtherPA OPTOMETRIC LICENSE