Provider Demographics
NPI:1427341734
Name:JOHNSON, JULIE BETH (LDO)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:BETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 DENALI ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-1342
Mailing Address - Country:US
Mailing Address - Phone:907-444-8854
Mailing Address - Fax:
Practice Address - Street 1:5710 DENALI ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1342
Practice Address - Country:US
Practice Address - Phone:907-444-8854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK276156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician