Provider Demographics
NPI:1922299700
Name:JOHNSON, BRANDI LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:31870 E HIGHWAY 51
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429-7900
Mailing Address - Country:US
Mailing Address - Phone:918-279-3200
Mailing Address - Fax:
Practice Address - Street 1:4444 S. HARVARD AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2611
Practice Address - Country:US
Practice Address - Phone:918-747-2020
Practice Address - Fax:918-747-2056
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2534152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist