Active NPI
Andrew D. Johnson, O.D., P.C.
- Point of Service
- Roswell, NM
National Provider Identifier
1235429150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Point of Service
- License
- NM0544
- 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
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.
- 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) | Code | License | State | Primary |
|---|---|---|---|---|
| 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 ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 DirectoryLocations
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.