Provider Demographics
NPI:1013952092
Name:JOHNSON, DONALD EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:EDWARD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10495 SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-5045
Mailing Address - Country:US
Mailing Address - Phone:352-683-5220
Mailing Address - Fax:352-666-6513
Practice Address - Street 1:10495 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-5045
Practice Address - Country:US
Practice Address - Phone:352-683-5220
Practice Address - Fax:352-666-6513
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64590207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF74036Medicare UPIN
K4394Medicare ID - Type Unspecified
FL23794VMedicare PIN