Provider Demographics
NPI:1528019486
Name:JOHNSON, ROBERT L (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
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 1:1340 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
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0925152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909466Medicaid
NC410032461OtherRAIL RAOD MEIDCARE
NC28979OtherPARTNERS
NC410024383OtherRAIL ROAD MEDICARE
NC09458OtherBCBS FUQUAY OFFICE
NC8909458Medicaid
NC09466OtherBCBS GARNER OFFICE
NC5956719OtherAETNA
NC28979OtherPARTNERS
NC09458OtherBCBS FUQUAY OFFICE
NCT78802Medicare UPIN
NC8909458Medicaid
NC09466OtherBCBS GARNER OFFICE
NC8909466Medicaid
NC1381Medicare PIN