Delesie Petric Johnson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4493T Issued in TX

Practice address

9307 Foxgrove Way
San Antonio, TX 78251-4107

Phone

(210) 523-5276

Fax

(210) 523-5276

NPI assigned

Apr 18, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Delesie Petric Johnson Professional name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Networks

• TX HMO D-SNP
• NM HMO C-SNP
• TX HMO

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Markitta Samone Barnett, O.D.

  • Optometrist
  • Jbsa Ft Sam Houston, TX
  • NPI 1649478819
  Medicare reassignment
• RCP Eyecare, PC

  • Optometrist
  • Selma, TX
  • NPI 1821578030
  NPD (past)
• Trinity Vision Center,PA

  • Optometrist
  • Boerne, TX
  • NPI 1861694549
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003032970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9307 FOXGROVE WAY",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782514107",
            "telephone_number": "210-523-5276",
            "fax_number": "210-523-5276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9307 FOXGROVE WAY",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782514107",
            "telephone_number": "210-523-5276",
            "fax_number": "210-523-5276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DELESIE",
        "middle_name": "PETRIC",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "4493T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DELESIE",
            "last_name": "JOHNSON",
            "middle_name": "PETRIC",
            "prefix": "MRS.",
            "credential": "O.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Darlene Johnson, RN
• David Gary Johnson, MD
• David Michael Johnson, MD
• David W. Johnson, M.D.
• Deanna Johnson
• Dellona Starr Johnson, COTA
• Demi Johnson
• Deneisha Johnson
• Denise Yvette Johnson, LPC
• Derrick Johnson

• Optometrist in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.