Provider Demographics
NPI:1528371150
Name:JOHNSON, JAMIE BYRON (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:BYRON
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 1:8511 GEYER SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-4949
Mailing Address - Country:US
Mailing Address - Phone:501-568-4218
Mailing Address - Fax:501-568-5131
Practice Address - Street 1:8511 GEYER SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-4949
Practice Address - Country:US
Practice Address - Phone:501-568-4218
Practice Address - Fax:501-568-5131
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-25
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2650152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR188537722Medicaid
AR4T068Medicare PIN