Individual
STEPHANIE R. JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
46-7055
IL
152WV0400X
Vision Therapy Optometrist
Primary
046007055
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0046007055
—
IL
Enumeration date
02/01/2007
Last updated
01/18/2019
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