Provider Demographics
NPI:1598883423
Name:JIM A. JOHNSON, O.D., P.A.
Entity Type:Organization
Organization Name:JIM A. JOHNSON, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-827-1010
Mailing Address - Street 1:1820 S OHIO ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-6607
Mailing Address - Country:US
Mailing Address - Phone:785-827-1010
Mailing Address - Fax:
Practice Address - Street 1:1820 S OHIO ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-6607
Practice Address - Country:US
Practice Address - Phone:785-827-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1354-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1354-3OtherKANSAS LICENSE OPTOMETRY
KS0000651148OtherBLUE CROSS BLUESHIELD KS
KS018086Medicare ID - Type UnspecifiedMEDICARE
KSU22611Medicare UPIN