Brent Bundy Johnson, OD
Individual provider Active NPI Optometrist · Madison, NC
NPI 1235239641 · NPPES record last updated Oct 26, 2023
Key facts
- NPI
- 1235239641
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 1830 (NC)
- Practice address
- 714 Highway St
Madison, NC 27025-1508 - Phone
- (336) 427-2020
- Fax
- (336) 427-2022
- NPI assigned
- Sep 25, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 22
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Pennsylvania College of Optometry, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Myeyedr Optometry of North Carolina PLLC
Practice addresses (Care Compare)
3354 W Friendly Ave
Greensboro, NC 27410-4888
Phone (336) 387-0930
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160112001715 | NC | Practitioner - Optometry | 0446226476 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1830 | NC | MD | Marriage & Family Therapist |
| TUV 006646 | NY | MD | Optometrist |
| OET 008758 | PA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Myeyedr Optometry of North Carolina, PLLC | Optometrist | Current |
Accepting new patients |
| Myeyedr Optometry of North Carolina, PLLC | Optometrist | Current |
Accepting new patients |
| Myeyedr Optometry of North Carolina, PLLC | Optometrist | Current | Accepting new patients |
| Eye Care Associates OD PA | Optometrist | Past | Accepting new patients |
| Myeyedr Optometry of North Carolina | Optometrist | Past | Accepting new patients |
Locations
1960 Randolph Rd
Charlotte, NC 28207
Phone (704) 372-5332
812 S Van Buren Rd
Eden, NC 27288
Phone (336) 623-2020
3354 W Friendly Ave
Greensboro, NC 27410
Phone (336) 387-0930
5710 W Gate City Blvd
Ste Q
Greensboro, NC 27407
Phone (336) 856-8711
411A Pisgah Church Rd
Greensboro, NC 27455
Phone (336) 790-3502
3354 W Friendly Ave
Ste 147
Greensboro, NC 27410
Phone (336) 387-0930
714 Highway St
Madison, NC 27025
Phone (336) 427-2020
100 Professional Dr
Reidsville, NC 27320
Phone (336) 342-3336
1950 Old Gallows Rd
Ste 520
Vienna, VA 22182
8614 Westwood Center Dr
Fl 9
Vienna, VA 22182
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OET 008758 | PA | |
| Optometrist | 152W00000X | TUV 006646 | NY | |
| Optometrist | 152W00000X | 1830 | NC | Yes |
Addresses
Primary practice location
714 Highway St
Madison, NC 27025-1508
Mailing address
5783 East Lake Rd
Romulus, NY 14541
Phone (315) 283-8928
Other practice location 1
830 County Rt. 64
Wal-Mart Vision Center # 1976
Elmira, NY 14903
Phone (607) 739-5209
Other practice location 2
3354 W Friendly Ave
Greensboro, NC 27410-4888
Phone (336) 387-0930
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 44324 | Other | NY | DAVIS (3221) |
| 44944 | Other | PA | DAVIS (2528) |
| 44945 | Other | PA | DAVIS (1945) |
| 49273 | Other | NY | DAVIS (2992) |
| 000926375001 | Other | NY | HEALTHNOW (3221) |
| 46709 | Other | NY | SPECTERA (2992) |
| 55760 | Other | NY | DAVIS (1976) |
| JO 1634168 | Other | NY | HIGHMARK (2992) |
| 44519 | Other | NY | SPECTERA (1976) |
| 000160882 | Other | NY | EXCELLUS (3221) |
| 44281 | Other | PA | SPECTERA (1945) |
| JO 1368847 | Other | PA | PENN BLUE SHIELD |
Other providers in Madison, NC
- Katherine Vaughan Hemberg
- Sadia Huma
- James P Lohr DMD PLLC
- Hannah James
- Judy Lynn Jeffrey
- Journey Towards Improved Health
- Journey Towards Improved Health
- Journey Towards Improved Health
- Britney Farrington Joyce
- Laboratory Corporation of America Holdings
All providers in Madison, NC · Optometrist in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 26, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.