Dale Johnson OD LLC

Primary specialty

Vision Therapy OptometristTaxonomy code 152WV0400X

License

4901002749 Issued in MI

Legal business name

DALE JOHNSON OD LLC

Practice address

724 Cedar St
Sault Sainte Marie, MI 49783-2410

Phone

(906) 632-2020

NPI assigned

May 16, 2006

Organization subpart

No

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

Authorized official

Name

Dale Johnson, OD

Title

Manager

Phone

(906) 632-2020

Specialties & licenses 1

Addresses

Other identifiers 3

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kylie Louise Kaczmarczyk, O.D.

  • Optometrist
  • Sault Sainte Marie, MI
  • NPI 1518918077
  NPD (past)

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438128000000",
    "number": "1609828870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "724 CEDAR ST",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497832410",
            "telephone_number": "906-632-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "724 CEDAR ST",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497832410",
            "telephone_number": "906-632-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DALE JOHNSON OD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2015-07-29",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DALE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "906-632-2020",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152WV0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist, Vision Therapy",
            "state": "MI",
            "license": "4901002749",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4578107",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PLUS BLUE",
            "identifier": "0P31680",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "900A710230",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kevin Dale Cranmer, DO
• Nelu Cristof, M.D.
• Jason Crouch
• Tom K Culina, OD
• Elizabeth Curtis
• Erin N Dankert
• David R Hunter DPM PC
• Emma David
• Kayla Davis
• Kelly Dean

• All providers in Sault Sainte Marie, MI
• Vision Therapy Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2015; 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.