David Earl Johanknecht, OD – Optometrist

Key facts

NPI: 1114078243
Entity type: Individual (NPI type 1)
Primary specialty: Optometrist 152W00000X
License: 1404-035 (WI)
Practice address: 269 Memorial Dr
Suite 103
Berlin, WI 54923
Phone: (920) 361-1696
Fax: (920) 361-1247
NPI assigned: Jan 16, 2007
Sex: Male
Sole proprietor: No

Organizations & group practices 2

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.

Berlin Family Eye Care SC Optometrist · Berlin, WI · NPI 1720139850

NPD (past) OPTOMETRIST
Berlin Family Eye Care SC Optometrist · Princeton, WI · NPI 1992925176

NPD (past) OPTOMETRIST

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
1404-035	WI	MD	Optometrist

Practice roles

Organization	Specialty	Status	New patients
Berlin Family Eye Care SC	Optometrist	Past since Jul 23, 2023	Accepting new patients
Berlin Family Eye Care SC	Optometrist	Past since Aug 1, 2001	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Optometrist	152W00000X	1404-035	WI	Yes

Addresses

Primary practice location

269 Memorial Dr
Suite 103
Berlin, WI 54923

Mailing address

PO Box 228
Berlin, WI 54923-0228
Phone (920) 361-1696

Other identifiers

Identifier	Type	State	Issuer
38563200	Medicaid	WI

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114078243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 228",
            "city": "BERLIN",
            "state": "WI",
            "postal_code": "549230228",
            "telephone_number": "920-361-1696",
            "fax_number": "920-361-1247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "269 MEMORIAL DR",
            "address_2": "SUITE 103",
            "city": "BERLIN",
            "state": "WI",
            "postal_code": "54923",
            "telephone_number": "920-361-1696",
            "fax_number": "920-361-1247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHANKNECHT",
        "first_name": "DAVID",
        "middle_name": "EARL",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "1404-035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38563200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berlin, WI

All providers in Berlin, WI · Optometrist in Wisconsin

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.