Cynthia Johnson, O.D.
Individual provider Active NPI Optometrist · Vermillion, SD
NPI 1063451276 · NPPES record last updated Feb 13, 2008
Key facts
- NPI
- 1063451276
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- SD153 (SD)
- Practice address
- 11 Shriner St
Vermillion, SD 57069-1155 - Phone
- (605) 624-2020
- NPI assigned
- Jun 5, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SD
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060822000044 | SD | Practitioner - Optometry | 8325041916 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SD153 | SD | MD | Optometrist |
| 153 | SD | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | SD153 | SD | Yes |
Addresses
Primary practice location
11 Shriner St
Vermillion, SD 57069-1155
Mailing address
11 Shriner St
Vermillion, SD 57069-1155
Phone (605) 624-2020
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9201670 | Medicaid | SD |
Other providers in Vermillion, SD
- Hy-Vee Inc
- Moses Nguu Ikiugu
- Sheila Rae Jacobson
- Phil D Jaquith
- Ashley Johnson
- Kylie Johnson
- Victoria Jo Johnson
- Susan Jane Jopling
- Jessica Jordan
- Becca D Jordre
All providers in Vermillion, SD · Optometrist in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 13, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.