Active NPI
Roger Dean Johnson, O.D.
- Optometrist
- Worthington, MN
National Provider Identifier
1821023979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1545
- Practice address
- 702 10TH St
Worthington, MN 56187-2767 - Phone
- (507) 376-5535
- Fax
- (507) 376-4805
- NPI assigned
- Jul 11, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1545 | MN | Primary |
Addresses
Primary practice location
702 10TH St
Worthington, MN 56187-2767
Mailing address
702 10TH St
Worthington, MN 56187-2767
Phone (507) 376-5535
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 454523100 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1545 | MN | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1425340800000",
"number": "1821023979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "702 10TH ST",
"city": "WORTHINGTON",
"state": "MN",
"postal_code": "561872767",
"telephone_number": "507-376-5535",
"fax_number": "507-376-4805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "702 10TH ST",
"city": "WORTHINGTON",
"state": "MN",
"postal_code": "561872767",
"telephone_number": "507-376-5535",
"fax_number": "507-376-4805"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "ROGER",
"middle_name": "DEAN",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-11",
"last_updated": "2015-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "1545",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "454523100",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Worthington, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.