NPIMap

Organization Active NPI

Cynthia G Johnson OD SC

  • Optometrist
  • Milwaukee, WI
National Provider Identifier
1407079981
Registry record updated Aug 22, 2020
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Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2246035 Issued in WI
Legal business name
CYNTHIA G JOHNSON OD SC
Practice address
2500 Mayfair Rd
Dean and Fletcher
Milwaukee, WI 53226
Phone
(414) 771-8999
NPI assigned
Apr 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Cynthia G Johnson, OD
Title
Optometrist President
Phone
(262) 886-4629

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 2246035 WI Primary

Addresses

Primary practice location

2500 Mayfair Rd
Dean and Fletcher
Milwaukee, WI 53226

Mailing address

6641 Mariner Dr
# 1
Racine, WI 53406
Phone (262) 886-4629

Other identifiers 1

IdentifierTypeStateIssuer
38576600MedicaidWI

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407079981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6641 MARINER DR",
            "address_2": "# 1",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "53406",
            "telephone_number": "262-886-4629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 MAYFAIR RD",
            "address_2": "DEAN AND FLETCHER",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53226",
            "telephone_number": "414-771-8999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CYNTHIA G JOHNSON OD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OPTOMETRIST PRESIDENT",
        "authorized_official_telephone_number": "262-886-4629",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2246035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38576600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.