Active NPI
Randel Edward Johanson, R.D.O.
- Optician
- Chico, CA
National Provider Identifier
1902988074
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- D3437
- Practice address
- 1722 Mangrove Ave
Suite 32
Chico, CA 95926-2300 - Phone
- (530) 895-1474
- Fax
- (530) 895-1441
- NPI assigned
- Oct 19, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | D3437 | CA | Primary |
Addresses
Primary practice location
1722 Mangrove Ave
Suite 32
Chico, CA 95926-2300
Mailing address
1722 Mangrove Ave
Suite 32
Chico, CA 95926-2300
Phone (530) 895-1474
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D3437 | CA | MD | Optician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chico Optical Dispensers | 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
- Chico, CA
- NPI 1417135328
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902988074",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1722 MANGROVE AVE",
"address_2": "SUITE 32",
"city": "CHICO",
"state": "CA",
"postal_code": "959262300",
"telephone_number": "530-895-1474",
"fax_number": "530-895-1441"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1722 MANGROVE AVE",
"address_2": "SUITE 32",
"city": "CHICO",
"state": "CA",
"postal_code": "959262300",
"telephone_number": "530-895-1474",
"fax_number": "530-895-1441"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHANSON",
"first_name": "RANDEL",
"middle_name": "EDWARD",
"credential": "R.D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "CA",
"license": "D3437",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chico, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.