Individual provider Active NPI

Jeany Johnson, OD

  • Optometrist
  • Buena Park, CA
National Provider Identifier
1992225056
Registry record updated Jun 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
33670 Issued in CA
Practice address
5610 River Way
Buena Park, CA 90621-1744
Phone
(317) 340-5782
NPI assigned
Jun 21, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 33670 CA Primary

Addresses

Primary practice location

5610 River Way
Buena Park, CA 90621-1744

Mailing address

5610 River Way
Buena Park, CA 90621

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20220304001423 TX Practitioner - Optometry 9032465935 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Indiana University - School of Optometry, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aeg Texas Professional PLLCGroup PAC ID 4486985678, 228 clinicians

Practice addresses (Care Compare)

4301 W William Cannon Dr
Suite 210
Austin, TX 78749-1473
Phone (512) 328-0015

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Aeg Texas Professional PLLC Optometrist CurrentSince Dec 1, 2021 Accepting new patients
Janet B Ogletree OD PA Optometrist PastSince Nov 1, 2016 Accepting new patients

Locations

111 E 4th St
Ste 440
Alton, IL 62002

3908 Far West Blvd
Austin, TX 78731
Phone (512) 343-0432

4301 W William Cannon Dr
Ste 210
Austin, TX 78749
Phone (512) 328-0015

4301 W William Cannon Dr
#210
Austin, TX 78749
Phone (512) 328-0015

3551 Justin Rd
Ste 150
Flower Mound, TX 75028
Phone (210) 490-9205

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1498003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1498003200000",
    "number": "1992225056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5610 RIVER WAY",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "90621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5610 RIVER WAY",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906211744",
            "telephone_number": "317-340-5782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JEANY",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-21",
        "last_updated": "2017-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "33670",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buena Park, CA

Sources for this page

Verify at the official NPI Registry.