Provider Demographics
NPI:1780742908
Name:JOHNSON EYECARE, P.C.
Entity type:Organization
Organization Name:JOHNSON EYECARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:563-359-4446
Mailing Address - Street 1:1875 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3203
Mailing Address - Country:US
Mailing Address - Phone:563-359-4446
Mailing Address - Fax:563-359-0381
Practice Address - Street 1:1875 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3203
Practice Address - Country:US
Practice Address - Phone:563-359-4446
Practice Address - Fax:563-359-0381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA02142152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IADE1662OtherPALMETTO GBA
IADE1662OtherPALMETTO GBA
6018600001Medicare NSC
IA93866Medicare UPIN
IA6018600001Medicare NSC