Johnathan Vickerson, LDO

Primary specialty

OpticianTaxonomy code 156FX1800X

License

002489 Issued in GA

Practice address

7325 Jonesboro Rd
Morrow, GA 30260-2950

Phone

(404) 583-5162

Fax

(678) 422-0759

NPI assigned

Nov 20, 2023

Last updated

Nov 20, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1700438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700438400000",
    "number": "1164297115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7325 JONESBORO RD",
            "city": "MORROW",
            "state": "GA",
            "postal_code": "302602950",
            "telephone_number": "404-583-5162",
            "fax_number": "678-422-0759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7325 JONESBORO RD",
            "city": "MORROW",
            "state": "GA",
            "postal_code": "302602950",
            "telephone_number": "404-583-5162",
            "fax_number": "678-422-0759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICKERSON",
        "first_name": "JOHNATHAN",
        "name_prefix": "Mr.",
        "credential": "LDO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-11-20",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FC0800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Contact Lens",
            "state": "NU",
            "license": "002489",
            "primary": false
        },
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "GA",
            "license": "002489",
            "primary": true
        },
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optician in Morrow, GA
• Providers in Morrow, GA by specialty
• Optician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.