Individual provider Active NPI

Johnson Ly, OD

  • Optometrist
  • Plano, TX
National Provider Identifier
1164076949
Registry record updated Sep 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
9736 Issued in TX
Practice address
2313 W Parker Rd
Plano, TX 75023-7839
Phone
(972) 612-2015
Fax
(972) 867-5454
NPI assigned
Jul 30, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 9736 TX Primary

Addresses

Primary practice location

2313 W Parker Rd
Plano, TX 75023-7839

Mailing address

8614 Westwood Center Dr FL 9
Vienna, VA 22182-2442
Phone (703) 847-8899

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20200508000935 TX Practitioner - Optometry 2365873247 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Med Southwest PLLCGroup PAC ID 4082952874, 234 clinicians

Practice addresses (Care Compare)

2313 W Parker Rd
Plano, TX 75023-7839
Phone (972) 612-2015

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9736TXMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Med Southwest, PLLC Optometrist CurrentSince May 11, 2020 Accepting new patients
Med Southwest, PLLC Optometrist CurrentSince May 11, 2020 Accepting new patients
Med Southwest, PLLC Optometrist Current Accepting new patients
Silver Spring Optometry, LLC Optometrist Past Accepting new patients

Locations

3012 E Hebron Pkwy
Ste 100
Carrollton, TX 75010
Phone (972) 307-5000

6446 Lyndon B Johnson Fwy
Dallas, TX 75240
Phone (972) 960-2020

11888 Marsh Ln
Ste 114
Dallas, TX 75234
Phone (972) 241-8084

2313 W Parker Rd
Plano, TX 75023
Phone (972) 612-2015

3405 Midway Rd
Ste 421
Plano, TX 75093
Phone (972) 801-2727

2703 Richmond Rd
Texarkana, TX 75503
Phone (903) 838-0783

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

1950 Old Gallows Rd
Ste 520
Vienna, VA 22182

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": "1564444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726099200000",
    "number": "1164076949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8614 WESTWOOD CENTER DR FL 9",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221822442",
            "telephone_number": "703-847-8899",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2313 W PARKER RD",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750237839",
            "telephone_number": "972-612-2015",
            "fax_number": "972-867-5454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LY",
        "first_name": "JOHNSON",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-30",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "9736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plano, TX

Sources for this page

Verify at the official NPI Registry.