Provider Demographics
NPI:1992907638
Name:JOHNSON, ROBERT H (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
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 1:3720 NW 13TH ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-5906
Mailing Address - Country:US
Mailing Address - Phone:352-332-8792
Mailing Address - Fax:
Practice Address - Street 1:3720 NW 13TH ST
Practice Address - Street 2:SUITE 12
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-5906
Practice Address - Country:US
Practice Address - Phone:352-332-8792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA883152WC0802X
FLOPC 1478152WC0802X
FLOPC1478152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19564Medicare ID - Type Unspecified
FL36624Medicare UPIN