Individual provider Active NPI

Tiffany J Johnson, O.D.

  • Optometrist
  • Saint Louis, MO
National Provider Identifier
1255466728
Registry record updated Nov 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2005025566 Issued in MO
Practice address
9540 Manchester Rd
Saint Louis, MO 63119-1313
Phone
(314) 962-3830
Fax
(314) 962-3909
NPI assigned
Feb 23, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2005025566 MO Primary

Addresses

Primary practice location

9540 Manchester Rd
Saint Louis, MO 63119-1313

Mailing address

40 E North St
Eureka, MO 63025-1205
Phone (636) 200-4393

Other names 1

  • Dr. Tiffany J Stuckey Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051027000055 MO Practitioner - Optometry 2961429121 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Indiana University - School of Optometry, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clarkson Optometry IncGroup PAC ID 0840411799, 82 clinicians

Practice addresses (Care Compare)

3122 S Grand Blvd
The Spec Shoppe
St Louis, MO 63118-1012
Phone (314) 450-7313

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2005025566MOMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Clarkson Optometry, Inc Optometrist CurrentSince Aug 20, 2014 Accepting new patients
Clarkson Optometry Inc Optometrist CurrentSince Aug 20, 2014 Accepting new patients
Clarkson Eyecare Optometrist Past Accepting new patients

Locations

14842 Manchester Rd
Ballwin, MO 63011
Phone (636) 557-2020

32 Four Seasons Shopping Ctr
Chesterfield, MO 63017
Phone (314) 469-3937

1729 Clarkson Rd
Chesterfield, MO 63017
Phone (636) 733-0090

17249 Chesterfield Airport Rd
Chesterfield, MO 63005
Phone (636) 787-0085

1028 Town and Country Crossing Dr
Chesterfield, MO 63017
Phone (636) 230-9190

12681 Dorsett Rd
Maryland Heights, MO 63043
Phone (314) 786-3800

9082 Overland Plz
Overland, MO 63114
Phone (314) 227-1132

330 W Osage St
Pacific, MO 63069
Phone (636) 271-4500

3122 S Grand Blvd
Saint Louis, MO 63118
Phone (314) 450-7313

9540 Manchester Rd
Saint Louis, MO 63119
Phone (314) 962-3830

6415 Chippewa St
Saint Louis, MO 63109
Phone (314) 457-1880

7335 Manchester Rd
Saint Louis, MO 63143
Phone (314) 645-1475

Interoperability endpoints

  • Direct secure messaging: tiffanyjohnson@direct.eyecare-partners.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416268800000",
    "number": "1255466728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 E NORTH ST",
            "city": "EUREKA",
            "state": "MO",
            "postal_code": "630251205",
            "telephone_number": "636-200-4393",
            "fax_number": "636-938-2650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9540 MANCHESTER RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631191313",
            "telephone_number": "314-962-3830",
            "fax_number": "314-962-3909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TIFFANY",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-23",
        "last_updated": "2014-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2005025566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIFFANY",
            "last_name": "STUCKEY",
            "middle_name": "J",
            "prefix": "DR.",
            "credential": "O.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.