Johnathan Carroll O.D. PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

8104TG Issued in TX

Legal business name

JOHNATHAN CARROLL O.D. PLLC

Practice address

2681 Gattis School Rd Ste 100
Round Rock, TX 78664-2057

Phone

(512) 898-9995

Fax

(512) 898-9994

NPI assigned

Aug 21, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Johnathan Marvin Carroll, O.D.NPI 1699026963

Title

Owner

Phone

(512) 898-9995

Specialties & licenses 1

Addresses

Other names 1

• Double Creek Eye Care Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Johnathan Marvin Carroll, O.D.

  • Optometrist
  • Round Rock, TX
  • NPI 1699026963
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1503273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1366968463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2681 GATTIS SCHOOL RD STE 100",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786642057",
            "telephone_number": "512-898-9995",
            "fax_number": "512-898-9994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2681 GATTIS SCHOOL RD STE 100",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786642057",
            "telephone_number": "512-898-9995",
            "fax_number": "512-898-9994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNATHAN CARROLL O.D. PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-21",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "CARROLL",
        "authorized_official_first_name": "JOHNATHAN",
        "authorized_official_middle_name": "MARVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "512-898-9995",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "TX",
            "license": "8104TG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Double Creek Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jaycie Brynn Jobe, MA, BCBA, LBA
• Andrea Lynn Jobes, LMSW
• David Tong Chung Joe, RPH
• Julie Joffray, LPC
• Jayesh John
• Khristofer Johnsen
• Adam James Johnson, DPT
• Ariana Deanda Adams Johnson
• Bobby Johnson Jr., DO
• Brook Voitier Johnson, M.A.

• Optometrist in Round Rock, TX
• Providers in Round Rock, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.