Dale Johnson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901002749 Issued in MI

Practice address

724 Cedar St
Sault Sainte Marie, MI 49783-2410

Phone

(906) 632-2020

NPI assigned

May 12, 2006

Last updated

Jul 29, 2015By the provider in NPPES

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sault Tribe of Chippewa Indians

  • Optometrist
  • Sault Sainte Marie, MI
  • NPI 1902074586
  Medicare reassignment NPD
• Dale Johnson OD LLC

  • Vision Therapy Optometrist
  • Sault Sainte Marie, MI
  • NPI 1609828870
  Authorized official Same address or phone
• Sault Tribe of Chippewa Indians

  • Family Nurse Practitioner
  • Sault Sainte Marie, MI
  • NPI 1205004884
  NPD
• Sault Tribe of Chippewa Indians

  dba Healing Place

  • Federally Qualified Health Center (FQHC)
  • Sault Sainte Marie, MI
  • NPI 1477389740
  NPD
• Sault Tribe of Chippewa Indians

  • Federally Qualified Health Center (FQHC)
  • Sault Sainte Marie, MI
  • NPI 1477721058
  NPD
• Sault Tribe of Chippewa Indians

  • Clinical Medical Laboratory
  • Sault Sainte Marie, MI
  • NPI 1750434395
  NPD
• Brian Matthews O.D. L.L.C.

  • Optometrist
  • Sault Sainte Marie, MI
  • NPI 1487958609
  NPD (past)
• Optom Eye Care LLC

  • Optometrist
  • Sault Sainte Marie, MI
  • NPI 1134622525
  NPD (past)
• SVC Inc.

  • Optometrist
  • Troy, MI
  • NPI 1376790279
  NPD (past)

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438128000000",
    "number": "1629029095",
    "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": {
        "last_name": "JOHNSON",
        "first_name": "DALE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2015-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901002749",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PLUS BLUE",
            "identifier": "P31680002",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "DJ002749",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Iron Mountain Vamc
• Amanda Isrow
• Jagannathan Neurosurgical Institute PLLC
• Jeffrey R Peterman MD PC
• Amy Jo Joel
• Edward N. Johnson, M.D.
• Mary Johnson, R.N.
• Sandra Ellen Johnson
• Lindsay J Johnston, D.C.
• Joseph M. Garlinghouse MD PC

• Optometrist in Sault Sainte Marie, MI
• Providers in Sault Sainte Marie, MI by specialty
• 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.
• 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.