Organization Active NPI

Eagle Vision Eye Care Optometric Group

  • Optometrist
  • Sacramento, CA
National Provider Identifier
1174708804
Registry record updated Aug 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
EAGLE VISION EYE CARE OPTOMETRIC GROUP
Practice address
5777 Greenback LN.
Ste 100
Sacramento, CA 95841-2013
Phone
(916) 231-0034
Fax
(916) 231-0038
NPI assigned
Dec 31, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2011

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

Authorized official

Name
Dr. Michael Wayne Johnson, OD
Title
Optometrist/Owner
Phone
(916) 231-0034

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

5777 Greenback LN.
Ste 100
Sacramento, CA 95841-2013

Mailing address

5777 Greenback LN.
Ste 100
Sacramento, CA 95841-2013
Phone (916) 231-0034

Other identifiers 1

IdentifierTypeStateIssuer
CT764AMedicaidCA

National Provider Directory

National Provider Directory

Locations

100 S Harding Blvd
Ste 100
Roseville, CA 95678
Phone (916) 549-4839

100 S Harding Blvd
#100
Roseville, CA 95678

100 S Harding Blvd
Ste 1
Roseville, CA 95678
Phone (916) 545-2787

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1199059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314576000000",
    "number": "1174708804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5777 GREENBACK LN.",
            "address_2": "STE 100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958412013",
            "telephone_number": "916-231-0034",
            "fax_number": "916-231-0038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5777 GREENBACK LN.",
            "address_2": "STE 100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958412013",
            "telephone_number": "916-231-0034",
            "fax_number": "916-231-0038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE VISION EYE CARE OPTOMETRIC GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-31",
        "last_updated": "2011-08-29",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "OPTOMETRIST/OWNER",
        "authorized_official_telephone_number": "916-231-0034",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CT764A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2011; 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.