Provider Demographics
NPI:1467474510
Name:JOHNSON, JAMES CHARLES (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CHARLES
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 E HIGH ST
Mailing Address - Street 2:STE 300
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3239
Mailing Address - Country:US
Mailing Address - Phone:610-689-8181
Mailing Address - Fax:
Practice Address - Street 1:1800 E HIGH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3239
Practice Address - Country:US
Practice Address - Phone:610-705-3937
Practice Address - Fax:610-705-3903
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG-001758152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOEG-1758OtherSTATE LICENSE
PA0048919000OtherIBC/KEYSTONE
PAT30277Medicare UPIN
PA0048919000OtherIBC/KEYSTONE
P01097317Medicare PIN