Provider Demographics
NPI:1740619824
Name:DR STEPHANIE L JOHNSON, PA
Entity type:Organization
Organization Name:DR STEPHANIE L JOHNSON, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-237-7997
Mailing Address - Street 1:7749 NORMANDY BLVD STE 121
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-7658
Mailing Address - Country:US
Mailing Address - Phone:904-237-7997
Mailing Address - Fax:904-269-9104
Practice Address - Street 1:7749 NORMANDY BLVD STE 121
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-7658
Practice Address - Country:US
Practice Address - Phone:904-237-7997
Practice Address - Fax:904-269-9104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2964152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU20707Medicare UPIN