Basic Information
| Provider Information | |||||||||
| NPI: | 1083822696 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 940 COMMONWEALTH AVE SUITE | ||||||||
| Address2: | NEW ENGLAND EYE INSTITUTE | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175875511 | ||||||||
| FaxNumber: | 6175875512 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 STUART ST | ||||||||
| Address2: | NEW ENGLAND EYE AT RENAISSANCE SCHOOL | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021165435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173570900 | ||||||||
| FaxNumber: | 6175875514 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 03/05/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4575 | MA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 95823001 | 01 | MA | NETWORK HEALTH | OTHER | 9679519 | 01 | MA | CIGNA | OTHER | 5068093 | 01 | MA | AETNA | OTHER | 0044301 | 01 | MA | NHP | OTHER | MA4575 | 01 | MA | EYEMED | OTHER | 0712906 | 05 | MA | MEDICAID | AA89356 | 01 | MA | HARVARD PILGRIM | OTHER |