Provider Demographics
NPI:1316139017
Name:JOHNSON, KAREN NICOLE (OD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:NICOLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E MAIN ST
Mailing Address - Street 2:HENDERSON FAMILY EYE CARE, PLLC
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-2439
Mailing Address - Country:US
Mailing Address - Phone:731-435-1275
Mailing Address - Fax:731-435-1276
Practice Address - Street 1:401 E MAIN ST
Practice Address - Street 2:HENDERSON FAMILY EYE CARE, PLLC
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-2439
Practice Address - Country:US
Practice Address - Phone:731-435-1275
Practice Address - Fax:731-435-1276
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2742152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00411915OtherRAILROAD MEDICARE
TN3590016Medicaid
TN3590017Medicare PIN