Johnson Vision Development Center, LLC

Primary specialty

Pediatric OptometristTaxonomy code 152WP0200X

Legal business name

JOHNSON VISION DEVELOPMENT CENTER, LLC

Practice address

1012 Greystone Square
Jackson, TN 38305

Phone

(731) 660-1100

Fax

(731) 660-0688

NPI assigned

Feb 2, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Paula Johnson-Wyatt, OD

Title

Owner/Optometrist

Phone

(731) 660-1100

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

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

{
    "created_epoch": "1328140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569369600000",
    "number": "1235401514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1012 GREYSTONE SQUARE",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "38305",
            "telephone_number": "731-660-1100",
            "fax_number": "731-660-0688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 GREYSTONE SQUARE",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "38305",
            "telephone_number": "731-660-1100",
            "fax_number": "731-660-0688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSON VISION DEVELOPMENT CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-02",
        "last_updated": "2019-09-25",
        "status": "A",
        "authorized_official_last_name": "JOHNSON-WYATT",
        "authorized_official_first_name": "PAULA",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "731-660-1100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152WP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Vision Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5440904",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q028220",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shirish Joglekar, MD
• John B Woods, MD
• John W. Crowder, D.D.S.,P.C.
• Hannah Russell Johns, MD
• Tina M Johns, CRNA
• Paula Johnson-Wyatt, OD
• Alyssa Faith Johnson, PT
• Amy E Johnson, M.D.
• Angela Jane Johnson, PHLEB/VENI,HOMEHEALT
• Anna Johnson

• Pediatric Optometrist in Jackson, TN
• Providers in Jackson, TN by specialty
• Pediatric Optometrist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.