Timothy Steven Johnson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

MN2741 Issued in MN

Practice address

12771 Riverdale Blvd NW Ste 103
Coon Rapids, MN 55448-1263

Phone

(763) 421-1220

NPI assigned

Feb 23, 2007

Last updated

Mar 17, 2018By 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 8

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

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 1999

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• JD Eyes, Inc

  dba Pearle Vision

  • Optometrist
  • Coon Rapids, MN
  • NPI 1609292077
  Medicare reassignment
• DRS. North & Watson, Optometrists P. a.

  • Optometrist
  • Bloomington, MN
  • NPI 1538199716
  NPD (past)
• Ocularra Holding. Inc

  dba Pearle Vision

  • Optometrist
  • Blaine, MN
  • NPI 1356498075
  NPD (past)
• Luxottica of America Inc

  dba Lenscrafters #E895

  • Eyewear Supplier
  • Kansas City, MO
  • NPI 1497412522
  NPD (past)

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1871629170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15426 VERDIN ST NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553044786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12771 RIVERDALE BLVD NW STE 103",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554481263",
            "telephone_number": "763-421-1220"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "570 Northtown Dr NE",
            "address_purpose": "LOCATION",
            "city": "Blaine",
            "state": "MN",
            "postal_code": "554341043",
            "country_code": "US",
            "telephone_number": "763-784-4081",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TIMOTHY",
        "middle_name": "STEVEN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-23",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "MN2741",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "MN2741",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "253223900",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "186G8JO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "22-03192",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "A01991022800",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "HP34135",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "173057",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "22-03191",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha Johnson
• Sarah Rose Johnson, RPH
• Shari A Johnson, DPT
• Steven Peter Johnson, LMFT
• Tiffany Johnson, RN
• Luella J Johnston, CRNA
• Christina Jones, PA-C
• Denise Rae Jones
• Julie M Jones, D.O.
• Teah S Jones

• Optometrist in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.