Individual provider Active NPI

Jay D. Johnson, OD

  • Optometrist
  • Norman, OK
National Provider Identifier
1104970052
Registry record updated Oct 31, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1085 Issued in OK
Practice address
1120 Rambling Oaks Drive
Norman, OK 73072
Phone
(405) 701-4114
Fax
(405) 801-3689
NPI assigned
Jan 22, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1085 OK Primary

Addresses

Primary practice location

1120 Rambling Oaks Drive
Norman, OK 73072

Mailing address

1120 Rambling Oaks Drive
Norman, OK 73072
Phone (405) 701-4114

Other identifiers 1

IdentifierTypeStateIssuer
200083870BMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20041210000902 OK Practitioner - Optometry 8325005309 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Robinson Eye Institute PLLCGroup PAC ID 4082701768, 3 clinicians

Practice addresses (Care Compare)

501 E Macarthur St
Shawnee, OK 74804-2201
Phone (405) 760-6500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
1085OKMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Robinson Eye Institute PLLC CurrentSince Jun 1, 2019 Accepting new patients
Robinson Eye Institute PLLC CurrentSince Jun 1, 2019 Accepting new patients
Dr Jay D Johnson Optometrist PLC Optometrist Past Accepting new patients
Eye Associates of Oklahoma PLLC Optometrist Past Accepting new patients

Locations

501 E MacArthur St
Shawnee, OK 74804
Phone (405) 275-7400

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 4

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": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477872000000",
    "number": "1104970052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 RAMBLING OAKS DRIVE",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "73072",
            "telephone_number": "405-701-4114",
            "fax_number": "405-801-3689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 RAMBLING OAKS DRIVE",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "73072",
            "telephone_number": "405-701-4114",
            "fax_number": "405-801-3689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JAY",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2016-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OK",
            "license": "1085",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200083870B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norman, OK

Sources for this page

Verify at the official NPI Registry.