Individual provider Active NPI

Michael Joel Johnson, O.D.

  • Optometrist
  • St Louis Park, MN
National Provider Identifier
1780710459
Registry record updated Mar 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2818 Issued in MN
Practice address
6099 Wayzata Blvd
St Louis Park, MN 55416-5538
Phone
(952) 204-5060
NPI assigned
Feb 26, 2007
Last updated
Mar 9, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2818 MN Primary

Addresses

Primary practice location

6099 Wayzata Blvd
St Louis Park, MN 55416-5538

Mailing address

3900 Park Nicollet Blvd
St Louis Park, MN 55416-2505
Phone (952) 993-3150

Other identifiers 6

IdentifierTypeStateIssuer
531P4JOOtherMNBCBS
OP6854OtherMNEYEMED
HP64503OtherMNHEALTH PARTNERS
133059OtherMNUCARE
22-03338OtherMNMEDICA
A01991033717OtherMNPREFERRED ONE

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20070503000404 MN Practitioner - Optometry 5496851735 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ovo Lasik and Lens LLCGroup PAC ID 8921497751, 7 clinicians

Practice addresses (Care Compare)

6099 Wayzata Blvd
Suite 120
Minneapolis, MN 55416-5538
Phone (952) 204-5060

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2818MNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ovo Lasik and Lens LLC CurrentSince Mar 11, 2022 Accepting new patients
The Total Vision Institute LLC PastSince Sep 1, 2017 Accepting new patients
Ocularra Holding. Inc Optometrist PastSince Dec 16, 2014 Accepting new patients
Hometown Eye Care, Inc Optometrist Past Accepting new patients

Locations

6099 Wayzata Blvd
St Louis Park, MN 55416
Phone (612) 871-1144

6099 Wayzata Blvd
Ste 100120
St Louis Park, MN 55416
Phone (952) 204-5060

6099 Wayzata Blvd
Ste 120
St Louis Park, MN 55416
Phone (952) 204-5060

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773014400000",
    "number": "1780710459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 PARK NICOLLET BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554162505",
            "telephone_number": "952-993-3150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6099 WAYZATA BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554165538",
            "telephone_number": "952-204-5060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MICHAEL",
        "middle_name": "JOEL",
        "name_prefix": "Mr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-26",
        "last_updated": "2026-03-09",
        "certification_date": "2026-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2818",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "531P4JO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "OP6854",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP64503",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "133059",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "22-03338",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "A01991033717",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

Verify at the official NPI Registry.