Provider Demographics
NPI:1356571822
Name:JOHNSON, EMILY MARIA (OD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:MARIA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:MARIA
Other - Last Name:FERNANDEZ JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:940 S SAINT FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-2335
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:940 S SAINT FRANCIS ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-2335
Practice Address - Country:US
Practice Address - Phone:316-264-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-19
Last Update Date:2022-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1839152W00000X
AZ1840152W00000X
NE1462152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist