Kenneth N Johnson

Primary specialty

OpticianTaxonomy code 156FX1800X

License

CT0001217 Issued in CT

Practice address

179 Flanders Rd
Niantic, CT 06357-1206

Phone

(860) 691-0279

NPI assigned

Nov 17, 2020

Last updated

Nov 17, 2020By 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1605571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605571200000",
    "number": "1710580436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "179 FLANDERS RD",
            "city": "NIANTIC",
            "state": "CT",
            "postal_code": "063571206",
            "telephone_number": "860-739-0279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "179 FLANDERS RD",
            "city": "NIANTIC",
            "state": "CT",
            "postal_code": "063571206",
            "telephone_number": "860-691-0279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KENNETH",
        "middle_name": "N",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-17",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "CT",
            "license": "CT0001217",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0001217",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1326280512",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rivka Sima Horowitz, MD
• Stanley H. Hospod III, LCSW
• Kathleen L Huffman, COTA
• Ashley James
• Kathryn Lee Johnson, MD
• Richard Frederick Jones III, MD
• Kristin Marie Kenny, APRN
• Kerry Lee LCSW LLC
• Lisa D King, LMT, RYT
• Jennifer A Koch

• Optician in Niantic, CT
• Providers in Niantic, CT by specialty
• Optician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; 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.