Provider Demographics
NPI:1689847048
Name:JOHNSON, STEVEN LOUIS (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:LOUIS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11401 VALLEY BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-3242
Mailing Address - Country:US
Mailing Address - Phone:626-448-6046
Mailing Address - Fax:626-448-7031
Practice Address - Street 1:11401 VALLEY BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-3242
Practice Address - Country:US
Practice Address - Phone:626-448-6046
Practice Address - Fax:626-448-7031
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 5885 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist