NPIMap

Organization Active NPI

Professional Visioncare LLC

  • Optometrist
  • Westerville, OH
National Provider Identifier
1730204694
Registry record updated Dec 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
PROFESSIONAL VISIONCARE LLC
Practice address
185 S State St
Westerville, OH 43081-2232
Phone
(614) 898-9989
Fax
(614) 898-3054
NPI assigned
Mar 20, 2007
Last updated
Dec 5, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2025

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

Authorized official

Name
Bradley J Johnson, O.D.NPI 1821254194
Title
Director
Phone
(614) 898-9989

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

185 S State St
Westerville, OH 43081-2232

Mailing address

185 S State St
Westerville, OH 43081-2232
Phone (614) 898-9989

Other identifiers 1

IdentifierTypeStateIssuer
2507666MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041116000144 OH Part B Supplier - Clinic/Group Practice 7911961370 Receives reassigned benefits from 18 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lewis Center, OH; Westerville, OH; Johnstown, OH

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

937 Polaris Woods Blvd
Ste B
Westerville, OH 43082
Phone (614) 898-5285

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764892800000",
    "number": "1730204694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "185 S STATE ST",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430812232",
            "telephone_number": "614-898-9989",
            "fax_number": "614-898-3054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 S STATE ST",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430812232",
            "telephone_number": "614-898-9989",
            "fax_number": "614-898-3054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL VISIONCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2025-12-05",
        "certification_date": "2025-12-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "614-898-9989",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2507666",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Westerville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.