Tanner Owen Johnson

Primary specialty

OptometristTaxonomy code 152W00000X

License

2811 Issued in NC

Practice address

504 Village Walk Dr
Holly Springs, NC 27540-4440

Phone

(919) 351-8600

Fax

(314) 741-4947

NPI assigned

Apr 12, 2024

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 NC

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

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eyecare Specialties of North Carolina OD PLLCGroup PAC ID 8820462252, 12 clinicians

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.

• Eyecare Specialties of North Carolina OD PLLC

  • Optometrist
  • Holly Springs, NC
  • NPI 1699483586
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1712880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738886400000",
    "number": "1700630209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "928 HARVEST POINT DR",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275265588",
            "telephone_number": "252-876-7073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 VILLAGE WALK DR",
            "city": "HOLLY SPRINGS",
            "state": "NC",
            "postal_code": "275404440",
            "telephone_number": "919-351-8600",
            "fax_number": "314-741-4947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TANNER",
        "middle_name": "OWEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-04-12",
        "last_updated": "2025-02-07",
        "certification_date": "2025-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "2811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey D Connell DMD PLLC
• Jennifer Putt Group, PLLC
• Ariana Sloane Johnson, DPT
• Kenyatta Nicole Johnson, LCSW-P
• Madison T Johnson
• Jonathan Z Wang DDS PLLC
• Gayla A. Jones, LCMHC
• Joshua'S Tree, LLC
• Julie Kennedy Nutrition
• Taniyah Justice

• Optometrist in Holly Springs, NC
• Providers in Holly Springs, NC by specialty
• Optometrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2025; 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.