Individual provider Active NPI

Lindsay Johnson Marshburn, O.D.

  • Optometrist
  • Decatur, GA
National Provider Identifier
1023431350
Registry record updated Jan 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
002775 Issued in GA
Practice address
104 Church St
Decatur, GA 30030-3325
Phone
(404) 378-3694
Fax
(404) 373-0741
NPI assigned
Jan 22, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 30, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 002775 GA Primary

Addresses

Primary practice location

104 Church St
Decatur, GA 30030-3325

Mailing address

104 Church St
Decatur, GA 30030-3325
Phone (404) 378-3694

Other names 1

  • Dr. Lindsay Eileen Johnson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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

Enrollment IDStateProvider typePAC IDDetails
I20150123001642 GA Practitioner - Optometry 0345564209 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
002775GAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eyecare Plus LLC CurrentSince Jun 16, 2014 Accepting new patients
Reagin Decatur Group, LLC CurrentSince Aug 17, 2017 Accepting new patients
Reagin Optometric Group, P.a. Optometrist Past Accepting new patients

Locations

216 Church St
Decatur, GA 30030
Phone (404) 378-3694

104 Church St
Decatur, GA 30030
Phone (404) 378-3694

301 Petrol Pt
#B
Peachtree Cty, GA 30269
Phone (770) 487-2020

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1390348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548806400000",
    "number": "1023431350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 CHURCH ST",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300303325",
            "telephone_number": "404-378-3694",
            "fax_number": "404-373-0741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 CHURCH ST",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300303325",
            "telephone_number": "404-378-3694",
            "fax_number": "404-373-0741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARSHBURN",
        "first_name": "LINDSAY",
        "middle_name": "JOHNSON",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-01-22",
        "last_updated": "2019-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "002775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LINDSAY",
            "last_name": "JOHNSON",
            "middle_name": "EILEEN",
            "prefix": "DR.",
            "credential": "O.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Decatur, GA

Sources for this page

Verify at the official NPI Registry.