Karl David Johannessen, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC 2589 Issued in FL

Practice address

6300 N Wickham Rd
Unit 123
Melbourne, FL 32940-2028

Phone

(321) 751-7270

Fax

(321) 751-7769

NPI assigned

Jul 16, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Optometry

Education

Southern College of Optometry, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eye Doctors Optical Outlets PAGroup PAC ID 0042123846, 97 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network

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.

• Eye Doctors Optical Outlets PA

  • Optometrist
  • Orlando, FL
  • NPI 1164308771
  Medicare reassignment Care Compare group NPD
• Eye Doctors Optical Outlets PA

  • Optometrist
  • Clearwater, FL
  • NPI 1013108091
  NPD
• Eye Doctors Optical Outlets PA

  • Optometrist
  • Tampa, FL
  • NPI 1114012689
  NPD
• Eye Doctors Optical Outlets PA

  • Optometrist
  • Leesburg, FL
  • NPI 1497946479
  NPD (past)

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306863105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 120759",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329120759",
            "telephone_number": "321-298-7339",
            "fax_number": "321-751-7769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6300 N WICKHAM RD",
            "address_2": "UNIT 123",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329402028",
            "telephone_number": "321-751-7270",
            "fax_number": "321-751-7769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHANNESSEN",
        "first_name": "KARL",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 2589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elaina Joanou
• Nor A Jobarah
• Milan Jockovich, M.D.
• Joe M Creel, DDS, PA
• Joel Scalera DDS PA
• John D Mackenney PA (Space Coast Foot & Ankle Center)
• John J Bomalaski MD PA
• John J Marcin & Associates PA
• Haig Malcom John, DC
• McKenna E Johns

• Optometrist in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.