Jackson Vision LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901003631 Issued in MI

Legal business name

JACKSON VISION LLC

Practice address

817 W Ganson St
Jackson, MI 49202-4255

Phone

(517) 782-4300

Fax

(517) 782-4708

NPI assigned

Mar 2, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Steven G Johnson, O.D.NPI 1366413072

Title

Optometrist

Phone

(517) 782-4300

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Jackson Vision Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Steven G. Johnson, O.D.

  • Optometrist
  • Jackson, MI
  • NPI 1366413072

  MI, Optometrist

  Medicare reassignment NPD Authorized official
• Jeffrey Alan Koets, OD

  • Optometrist
  • Dewitt, MI
  • NPI 1093767881
  NPD (past)

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

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397606400000",
    "number": "1043349467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "817 W GANSON ST",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492024255",
            "telephone_number": "517-782-4300",
            "fax_number": "517-782-4708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 W GANSON ST",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492024255",
            "telephone_number": "517-782-4300",
            "fax_number": "517-782-4708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON VISION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-02",
        "last_updated": "2014-04-16",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "517-782-4300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "900C810850",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP #",
            "identifier": "22-20042",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Vision",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Jackson Urgent Care PLLC
• Jackson-Hillsdale Community Mental Health Board
• Jackson-Hillsdale Community Mental Health Board
• Jackson-Hillsdale Community Mental Health Board
• Jackson-Hillsdale Community Mental Health Board
• Jackson-Hillsdale Community Mental Health Board

• All providers in Jackson, MI
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.