Provider Demographics
NPI:1750333126
Name:JOHNSON OPTOMETRIC ASSOCIATES PA
Entity Type:Organization
Organization Name:JOHNSON OPTOMETRIC ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES OWNER
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:919-779-3560
Mailing Address - Street 1:918 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-3677
Mailing Address - Country:US
Mailing Address - Phone:919-779-3560
Mailing Address - Fax:919-779-5773
Practice Address - Street 1:918 7TH AVE
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-3677
Practice Address - Country:US
Practice Address - Phone:919-779-3560
Practice Address - Fax:919-779-5773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
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
NC09461OtherBCBS
NC8909461Medicaid
NC4493993OtherAETNA
NC8909461Medicaid
NC1382Medicare ID - Type Unspecified
DE 1984Medicare PIN