Bryan Lowell Johnson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2090 Issued in MN

Practice address

3630 11TH Ave NW
Rochester, MN 55901-4276

Phone

(507) 288-2457

Fax

(507) 288-1299

NPI assigned

Dec 1, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1243468800000",
    "number": "1184608200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3630 11TH AVE NW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559014276",
            "telephone_number": "507-288-2457",
            "fax_number": "507-288-1299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3630 11TH AVE NW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559014276",
            "telephone_number": "507-288-2457",
            "fax_number": "507-288-1299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "BRYAN",
        "middle_name": "LOWELL",
        "name_prefix": "Mr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-01",
        "last_updated": "2009-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2090",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP44093",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA CHOICE SELECT",
            "identifier": "2201134",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "4C934J0",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "549823700",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "01017733",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Johnson, LPCC
• Baylor Johnson, DO
• Becky A Johnson, D.C.
• Brian Jacob Johnson, MD
• Brianna Lee Johnson
• C Daniel Johnson, M.D.
• Callie L Johnson, NP
• Christopher Scott Johnson, M.D.
• Colleen G Johnson, OTR/L
• Curtiss Victor Johnson, DO

• Optometrist in Rochester, MN
• Providers in Rochester, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2009; 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.