Provider Demographics
NPI:1821110578
Name:JOHANNES, FERINE N (OD)
Entity Type:Individual
Prefix:DR
First Name:FERINE
Middle Name:N
Last Name:JOHANNES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:FERINE
Other - Middle Name:N
Other - Last Name:ALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:
Practice Address - Street 1:204 MIDTOWN DR
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-5203
Practice Address - Country:US
Practice Address - Phone:843-521-4037
Practice Address - Fax:843-521-0138
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1568152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA61528213Medicare PIN