Provider Demographics
NPI:1891447363
Name:JOHNSON, KYLEIGH (OD)
Entity Type:Individual
Prefix:DR
First Name:KYLEIGH
Middle Name:
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 1:8700 NE VANCOUVER MALL DR STE 232
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6418
Mailing Address - Country:US
Mailing Address - Phone:360-882-9355
Mailing Address - Fax:
Practice Address - Street 1:8700 NE VANCOUVER MALL DR STE 232
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6418
Practice Address - Country:US
Practice Address - Phone:360-882-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD.61276001152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist