Ellyn Victoria Johnson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1813 Issued in NC

Practice address

5380 US Highway 158
Suite 100
Advance, NC 27006-6907

Phone

(336) 940-2015

Fax

(336) 940-2069

NPI assigned

May 12, 2006

Last updated

Sep 29, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

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, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Carolina Center for Eye Care OD PAGroup PAC ID 7618863846, 6 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ellyn.johnson@direct.revolutionehr.com

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

• Carolina Center for Eye Care, OD PA

  • Optometrist
  • Advance, NC
  • NPI 1528141009
  Medicare reassignment Care Compare group NPD Authorized official
• Clark Optometric Center PA

  dba Triangle Visions Optometry

  • Optometrist
  • Durham, NC
  • NPI 1588619217
  NPD
• Moore Optometric Eye Center

  • Optometrist
  • Lexington, NC
  • NPI 1962456533
  NPD (past)
• Steven G. Laymon, OD, PA

  dba Mocksville Vision Center

  • Optometrist
  • Mocksville, NC
  • NPI 1164465134
  NPD (past)

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285718400000",
    "number": "1386694917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5380 US HIGHWAY 158",
            "address_2": "SUITE 100",
            "city": "ADVANCE",
            "state": "NC",
            "postal_code": "270066907",
            "telephone_number": "336-940-2015",
            "fax_number": "336-940-2069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5380 US HIGHWAY 158",
            "address_2": "SUITE 100",
            "city": "ADVANCE",
            "state": "NC",
            "postal_code": "270066907",
            "telephone_number": "336-940-2015",
            "fax_number": "336-940-2069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ELLYN",
        "middle_name": "VICTORIA",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-12",
        "last_updated": "2010-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "1813",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89093J4",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan Yurgel Hunsinger, M.D.
• Innovative Care, Inc. (B-Care Services)
• Kristen N Jablonski, RN, BSN
• Ellen Bradford James, COTA/L
• Donna S Johnson
• Anthony D Jones, PTA
• K&J Expert Home Solutions LLC
• Kind Words PLLC
• Hannah Marie Klepeisz, M.S. CCC-SLP
• Koala T Care, Inc

• Optometrist in Advance, NC
• Providers in Advance, NC by specialty
• Optometrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2010; 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.