Provider Demographics
NPI:1538215777
Name:JOHNSON, KEVIN LEE (OD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1016 GOLF CLUB CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-8885
Mailing Address - Country:US
Mailing Address - Phone:615-497-5512
Mailing Address - Fax:
Practice Address - Street 1:2021 CHURCH ST STE 300
Practice Address - Street 2:BAPTIST HOSPITAL, MEDICAL PLAZA 2
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2051
Practice Address - Country:US
Practice Address - Phone:615-340-4733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2419152WC0802X
CO1786152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management