Organization Active NPI

Andrew D. Johnson, O.D., P.C.

  • Point of Service
  • Roswell, NM
National Provider Identifier
1235429150
Registry record updated Apr 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Point of ServiceTaxonomy code 305S00000X
License
NM0544 Issued in NM
Legal business name
ANDREW D. JOHNSON, O.D., P.C.
Practice address
4500 N Main St
Roswell, NM 88201-0305
Phone
(575) 625-2020
Fax
(505) 622-7816
NPI assigned
Apr 12, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2011

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

Authorized official

Name
Dr. Andrew Daniel Johnson, O.D.NPI 1801975826
Title
President/Owner
Phone
(575) 625-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Point of Service 305S00000X NM0544 NM Primary

Addresses

Primary practice location

4500 N Main St
Roswell, NM 88201-0305

Mailing address

4500 N Main St
Roswell, NM 88201-0305
Phone (575) 625-2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111017000291 NM Part B Supplier - Clinic/Group Practice 0749452779 Receives reassigned benefits from 2 practitioners
Practice locations: Las Cruces, NM

National Provider Directory

National Provider Directory

Locations

3050 E Lohman Ave
Ste F
Las Cruces, NM 88011
Phone (575) 521-4053

3050 E Lohman Ave
Las Cruces, NM 88011

Practitioners & affiliated clinicians

Practitioners 2

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": "1302566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302566400000",
    "number": "1235429150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 N MAIN ST",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882010305",
            "telephone_number": "575-625-2020",
            "fax_number": "505-622-7816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 N MAIN ST",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882010305",
            "telephone_number": "575-625-2020",
            "fax_number": "505-622-7816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDREW D. JOHNSON, O.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-12",
        "last_updated": "2011-04-12",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "575-625-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "NM",
            "license": "NM0544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2011; 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.