Kimberly Johnson OD LLC
Organization Active NPI Optometrist · Gothenburg, NE
NPI 1245258292 · NPPES record last updated Jun 8, 2013
Key facts
- NPI
- 1245258292
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 1232 (NE)
- Legal business name
- KIMBERLY JOHNSON OD LLC
- Practice address
- 902 Avenue D
Ste 102 B
Gothenburg, NE 69138-1900 - Phone
- (308) 537-2020
- Fax
- (308) 537-2280
- NPI assigned
- Jul 18, 2006
- Organization subpart
- No
Authorized official
- Name
- Kimberly Johnson, O.D.
- Title
- Member
- Phone
- (308) 537-2020
Practitioners 1
-
Kimberly A Johnson, O.D.
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Kimberly Johnson OD LLC |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NE
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060906000583 | NE | Part B Supplier - Clinic/Group Practice | 9032113972 |
Receives reassigned benefits from 1 practitioner Practice locations: Gothenburg, NE |
| O20130521000348 | NE | DME Supplier - Physician - Optometrist | 9032113972 | Practice locations: Gothenburg, NE |
National Provider Directory
Locations
902 Avenue D
Ste 102B
Gothenburg, NE 69138
Phone (308) 532-0220
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 1232 | NE | Yes |
Addresses
Primary practice location
902 Avenue D
Ste 102 B
Gothenburg, NE 69138-1900
Mailing address
902 Avenue D
Ste 102 B
Gothenburg, NE 69138-1900
Phone (308) 537-2020
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 099868 | Other | NE | MEDICARE GROUP PROVIDER NUMBER |
| 10025277400 | Medicaid | NE |
Other names
- Gothenburg Eyecare & Optical
Other providers in Gothenburg, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2013. 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.
- 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.