Brent Warren Johnson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1650TX Issued in WA

Practice address

700 SE Chkalov Dr
Suite 5
Vancouver, WA 98683-5202

Phone

(360) 256-0612

Fax

(360) 896-5503

NPI assigned

Jan 22, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Ray Vision LLC

  • Optometrist
  • Vancouver, WA
  • NPI 1932777968
  NPD (past)

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205539200000",
    "number": "1710031463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 SE CHKALOV DR",
            "address_2": "SUITE 5",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986835202",
            "telephone_number": "360-256-0612",
            "fax_number": "360-896-5503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 SE CHKALOV DR",
            "address_2": "SUITE 5",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986835202",
            "telephone_number": "360-256-0612",
            "fax_number": "360-896-5503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "BRENT",
        "middle_name": "WARREN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2008-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "1650TX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2003523",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrea Kathaleen Johnson, MA
• Anna Marie Johnson
• Bayley Alexandra Johnson, MA
• Belen Eileen Johnson
• Bethany Rose Johnson
• Brett Charles Johnson, MSPT
• Bruce C. Johnson, M.D.
• Caran S Johnson, LMT
• Chacie Lynn Johnson, FNP-C
• Christopher Kirk Johnson, PH.D.

• Optometrist in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2008; 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.