Samuel Lee Johansen, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1872 Issued in SC

Practice address

214 Waller Ave
Greenwood, SC 29646-2747

Phone

(864) 992-6386

NPI assigned

Jun 17, 2015

Sex

Male

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 SC

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, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Johansen Precision Eye Care LLC

  • Optometrist
  • Greenwood, SC
  • NPI 1184009540

  SC

  Medicare reassignment Authorized official
• Precision Eye Care, Johansens and Brown, LLC

  • Optometrist
  • Greenville, SC
  • NPI 1437616638
  Medicare reassignment NPD

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

{
    "created_epoch": "1434499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553644800000",
    "number": "1497136139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 BYPASS 25 NE",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "29646",
            "telephone_number": "864-992-6386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 WALLER AVE",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296462747",
            "telephone_number": "864-992-6386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHANSEN",
        "first_name": "SAMUEL",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-17",
        "last_updated": "2019-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeremiah Investors
• Jessica & Company, LLC
• Jim Nasim
• Jim Nasim DMD PA
• Johansen Precision Eye Care LLC
• John Sprouse
• Chacko John, M.D.
• Allie Johnson, DPT
• Deshandra Felisha Johnson, LPC
• Jane Pruett Johnson, OTR/L

• All providers in Greenwood, SC
• Optometrist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2019; 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.