Individual provider Active NPI

Lawrence Johansen, O.D.

  • Optometrist
  • Appleton, WI
National Provider Identifier
1417908955
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
WI 2007 Issued in WI
Practice address
1000 W Northland Ave
Appleton, WI 54914-1419
Phone
(920) 731-4511
Fax
(920) 731-9332
NPI assigned
May 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X WI 2007 WI Primary

Addresses

Primary practice location

1000 W Northland Ave
Appleton, WI 54914-1419

Mailing address

1000 W Northland Ave
Appleton, WI 54914-1419
Phone (920) 731-4511

Other identifiers 1

IdentifierTypeStateIssuer
38525100MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20060615000204 WI Practitioner - Optometry 7911919865 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shoptikal LLCGroup PAC ID 1456684471, 192 clinicians

Practice addresses (Care Compare)

1033 W Northland Ave
Suite B
Appleton, WI 54914-1499
Phone (920) 731-4511

6000 Monona Dr
Suite 101
Monona, WI 53716-3329
Phone (608) 222-9420

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
WI 2007WIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Shoptikal LLC Optometrist CurrentSince May 16, 2019 Accepting new patients
Shoptikal LLC Optometrist CurrentSince May 16, 2019 Accepting new patients
Shopko Stores Operating Co LLC Past Accepting new patients

Locations

3525 E Calumet St
Ste 1400
Appleton, WI 54915
Phone (920) 788-4114

1000 W Northland Ave
Appleton, WI 54914
Phone (866) 455-8111

1490 Oneida St
Appleton, WI 54915
Phone (920) 725-3752

1033 W Northland Ave
Ste B
Appleton, WI 54914
Phone (920) 731-4511

N6663 Rolling Meadows Dr
Ste I
Fond du Lac, WI 54937
Phone (920) 921-8290

1073 E Johnson St
Fond du Lac, WI 54935
Phone (920) 375-5483

123 N Mall Dr
Grand Chute, WI 54913
Phone (920) 429-7842

2360 Costco Way
Ste 120
Green Bay, WI 54311
Phone (920) 468-4642

2268 W Mason St
Green Bay, WI 54303
Phone (920) 259-7068

2621 S Oneida St
Ste 104
Green Bay, WI 54304
Phone (920) 499-3511

3415 Calumet Ave
#3
Manitowoc, WI 54220
Phone (920) 683-2244

6000 Monona Dr
Ste 101
Monona, WI 53716
Phone (608) 222-9420

1154 Westowne Dr
Neenah, WI 54956
Phone (920) 751-0275

1212 S Koeller St
Oshkosh, WI 54902
Phone (920) 426-5730

1810 Jackson St
Oshkosh, WI 54901
Phone (920) 385-1262

4097 Highway 28
Unit 2
Sheboygan Falls, WI 53085
Phone (920) 458-5757

2314 Lineville Rd
Ste 104
Suamico, WI 54313
Phone (920) 434-5845

1745 S Main St
Unit 7
West Bend, WI 53095
Phone (262) 334-7077

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": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1417908955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 W NORTHLAND AVE",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549141419",
            "telephone_number": "920-731-4511",
            "fax_number": "920-731-9332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 W NORTHLAND AVE",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549141419",
            "telephone_number": "920-731-4511",
            "fax_number": "920-731-9332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHANSEN",
        "first_name": "LAWRENCE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "WI 2007",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38525100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.