Provider Demographics
NPI:1447513965
Name:JOHNSTON, KASSAUNDRA LEE (OD)
Entity type:Individual
Prefix:DR
First Name:KASSAUNDRA
Middle Name:LEE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5526 GRAPE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-1102
Mailing Address - Country:US
Mailing Address - Phone:713-339-0175
Mailing Address - Fax:
Practice Address - Street 1:505 J DAVIS ARMISTEAD BUILDING
Practice Address - Street 2:4901 CALHOUN
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77204-2020
Practice Address - Country:US
Practice Address - Phone:713-743-2020
Practice Address - Fax:713-743-0963
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7971TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112409104Medicaid
TX00E63GMedicare UPIN