Provider Demographics
NPI:1457448300
Name:JOHNSON OPTOMETRIC ASSOCIATES PA
Entity Type:Organization
Organization Name:JOHNSON OPTOMETRIC ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-552-3181
Mailing Address - Street 1:1340 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-2617
Mailing Address - Country:US
Mailing Address - Phone:919-552-3181
Mailing Address - Fax:919-552-0197
Practice Address - Street 1:1340 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2617
Practice Address - Country:US
Practice Address - Phone:919-552-3181
Practice Address - Fax:919-552-0197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2701064OtherAETNA
NC09459OtherBCBS
NCC 10278OtherRR MEDICARE
NC8909459Medicaid
NC09459OtherBCBS
NCC 10278OtherRR MEDICARE
NC1381Medicare PIN