Linda Johnson, O.D.
Individual provider Active NPI Optometrist · Jackson, MS
NPI 1417991985 · NPPES record last updated Dec 21, 2007
Key facts
- NPI
- 1417991985
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 478 (MS)
- Practice address
- 3502 W Northside Dr
Jackson, MS 39213-4454 - Phone
- (601) 362-5321
- Fax
- (601) 364-2600
- NPI assigned
- Jun 15, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Indiana University - School of Optometry, 1978
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Central Mississippi Civic Improvement Association, Inc
Practice addresses (Care Compare)
129 White Oak St
Utica, MS 39175-8803
Phone (601) 885-6021
3502 W Northside Dr
Jackson, MS 39213-4454
Phone (601) 362-5321
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080414000589 | MS | Practitioner - Optometry | 1951488022 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central Mississippi Civic Improvement Association, Inc | Current | Accepting new patients | |
| Central Mississippi Civic Improvement Association, Inc. | Current |
Accepting new patients | |
| Central Mississippi Civic Improvement Association, Inc. | Current |
Accepting new patients |
Locations
3502 W Northside Dr
Jackson, MS 39213
Phone (601) 982-1625
3502 W Northside Dr
Unit 5
Jackson, MS 39213
129 White Oak St
Utica, MS 39175
Phone (601) 885-6021
Interoperability endpoints
- linda.johnson@jhchc.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 478 | MS | Yes |
Addresses
Primary practice location
3502 W Northside Dr
Jackson, MS 39213-4454
Mailing address
3502 W Northside Dr
Jackson, MS 39213-4454
Phone (601) 362-5321
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00087883 | Medicaid | MS |
Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 21, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.