Jack F Johnson Jr., MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

6111 Issued in SC

Practice address

1190 Summers Ave
Orangeburg, SC 29115-4922

Phone

(803) 534-0266

NPI assigned

Aug 21, 2006

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 1

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Orangeburg Eye Center

  • Ophthalmology Physician
  • Orangeburg, SC
  • NPI 1194831586
  Medicare reassignment NPD
• Orangeburg Opticians

  • Eyewear Supplier
  • Orangeburg, SC
  • NPI 1689682510
  NPD (past)

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191888000000",
    "number": "1902912322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1226",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291161226",
            "telephone_number": "803-534-0266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1190 SUMMERS AVE",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291154922",
            "telephone_number": "803-534-0266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JACK",
        "middle_name": "F",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-21",
        "last_updated": "2007-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "SC",
            "license": "6111",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "061113",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sharon Alissa Johnson Brunson, MA CCC/SLP
• Johnson Transportation
• Brandi P Johnson, NP
• Claretha Johnson
• Doris W Johnson, MA REHAB COUNSELING
• Jim M Johnson Jr.
• Monica Monique Johnson, PMHNP
• Nicole Johnson
• Roger Dalton Johnson, CRNA
• Tambrea LC Johnson, PHARMACIST, PTA

• Ophthalmology Physician in Orangeburg, SC
• Providers in Orangeburg, SC by specialty
• Ophthalmology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.