Provider Demographics
NPI:1063599959
Name:JOHNSON, DAVID ARLINGTON (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ARLINGTON
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301B PETROL PT
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1552
Mailing Address - Country:US
Mailing Address - Phone:770-487-2020
Mailing Address - Fax:770-487-2720
Practice Address - Street 1:301B PETROL PT
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1552
Practice Address - Country:US
Practice Address - Phone:770-487-2020
Practice Address - Fax:770-487-2720
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA001105152WC0802X
GAOPT001105152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA379548557BMedicare ID - Type Unspecified
GA0810130001Medicare NSC
GAU22626Medicare UPIN