Samuel David Johnson, O.D.
Individual provider Active NPI Optometrist · Fairmont, NC
NPI 1962838565 · NPPES record last updated Sep 16, 2013
Key facts
- NPI
- 1962838565
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2337 (NC)
- Practice address
- 204 Iona St
Fairmont, NC 28340-1616 - Phone
- (910) 628-8316
- Fax
- (910) 628-5642
- NPI assigned
- Sep 16, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Southern College of Optometry, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Samuel D Johnson OD PLLC
Practice addresses (Care Compare)
204 Iona St
Fairmont, NC 28340-1616
Phone (910) 628-8316
8544 Brightleaf PL
Saint Pauls, NC 28384-9408
PO Box
Suite 648
Fairmont, NC 28340
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 43 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140319000538 | NC | Practitioner - Optometry | 0446487359 |
Reassigns benefits to 1 organization Receives reassigned benefits from 1 practitioner Practice locations: Fairmont, NC |
| I20260131000308 | NC | Practitioner - Optometry | 0446487359 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2337 | NC | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Samuel D Johnson OD PLLC | Optometrist | Current |
Accepting new patients |
| Fairmont Eye Clinic OD PLLC | Optometrist | Current |
Accepting new patients |
Locations
204 Iona St
Fairmont, NC 28340
Phone (910) 268-8316
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2337 | NC | Yes |
Addresses
Primary practice location
204 Iona St
Fairmont, NC 28340-1616
Mailing address
PO Box 648
Fairmont, NC 28340-0648
Phone (910) 628-8316
Other providers in Fairmont, NC
- Eugenia Brooks Howie
- Belicia J Hunt
- Jeffrey Lemont Hunter
- Independent Community-Based Services LLC
- Jackson Home, Inc.
- Kerr Drug Inc
- Brian Scott Ledbetter
- Linda Lee
- Life Changing Behavioral Health Services
- Life Changing Behavioral Health Services
All providers in Fairmont, NC · Optometrist in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.