Jessica Marie Johnson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046010220 Issued in IL

Practice address

3035 E Mound Rd
Decatur, IL 62526-9650

Phone

(217) 554-3000

NPI assigned

Jul 27, 2009

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

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1248652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355702400000",
    "number": "1457582389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3035 E MOUND RD",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625269650",
            "telephone_number": "217-554-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3035 E MOUND RD",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625269650",
            "telephone_number": "217-554-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JESSICA",
        "middle_name": "MARIE",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-27",
        "last_updated": "2012-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046010220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John C. Lee, M.D., S.C.
• John Herington, PC
• John R Wasem DC PC
• John W. Newlin, M.D., LLC
• David Martin Johnson, MD
• Mallory Noel Johnson
• Margaret Ellen Johnson, LCSW
• Nicholas Johnson
• Pierre Michael Johnson, M.D.
• Sara Lynn Johnson, APN

• Optometrist in Decatur, IL
• Providers in Decatur, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.