Active NPI
Donald J Johnson, OD
- Optometrist
- Klamath Falls, OR
National Provider Identifier
1841474731
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1642 ATI
- Practice address
- 3600 Washburn Way
Klamath Falls, OR 97603-4539 - Phone
- (541) 883-1669
- NPI assigned
- Dec 27, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1642 ATI | OR | Primary |
| Corneal and Contact Management Optometrist | 152WC0802X | 1642 ATI | OR | |
| Pediatric Optometrist | 152WP0200X | 1642ATI | OR | |
| Low Vision Rehabilitation Optometrist | 152WL0500X | 1642ATI | OR |
Addresses
Primary practice location
3600 Washburn Way
Klamath Falls, OR 97603-4539
Mailing address
PO Box 759
Ashland, OR 97520-0026
Phone (541) 488-1417
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 031380 | Medicaid | OR |
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 |
|---|---|---|---|
| 244 | AK | MD | Chiropractor |
| 1642 ATI | OR | MD | Optometrist |
| 1642ATI | OR | MD | Low Vision Rehabilitation Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medical Eye Center Optical Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Eyewear Supplier
- Grants Pass, OR
- NPI 1629242938
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198713600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202601600000",
"number": "1841474731",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 759",
"city": "ASHLAND",
"state": "OR",
"postal_code": "975200026",
"telephone_number": "541-488-1417"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3600 WASHBURN WAY",
"city": "KLAMATH FALLS",
"state": "OR",
"postal_code": "976034539",
"telephone_number": "541-883-1669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "DONALD",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-12-27",
"last_updated": "2008-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OR",
"license": "1642 ATI",
"primary": true
},
{
"code": "152WC0802X",
"taxonomy_group": "",
"desc": "Optometrist, Corneal and Contact Management",
"state": "OR",
"license": "1642 ATI",
"primary": false
},
{
"code": "152WP0200X",
"taxonomy_group": "",
"desc": "Optometrist, Pediatrics",
"state": "OR",
"license": "1642ATI",
"primary": false
},
{
"code": "152WL0500X",
"taxonomy_group": "",
"desc": "Optometrist, Low Vision Rehabilitation",
"state": "OR",
"license": "1642ATI",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "031380",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Klamath Falls, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 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.