Provider Demographics
NPI:1124320817
Name:JOHNSON, ANDREW JAMES (OD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JAMES
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1200 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118
Mailing Address - Country:US
Mailing Address - Phone:734-475-9953
Mailing Address - Fax:734-475-9063
Practice Address - Street 1:1200 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118
Practice Address - Country:US
Practice Address - Phone:734-475-9953
Practice Address - Fax:734-475-9063
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4901004866152WC0802X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics