Jimmy D Johnson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

847 Issued in NE

Practice address

17255 Davenport St
Omaha, NE 68118-4092

Phone

(402) 763-6466

NPI assigned

Feb 24, 2007

Sex

Male

Sole proprietor

Yes

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 NE

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

Medicare enrollment (NPD)

Enrolled

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.

• West Point Optical Group

  • Optometrist
  • Novi, MI
  • NPI 1831548890

  NE

  Medicare reassignment NPD
• Vision Assoicates Inc

  • Optometrist
  • Lincoln, NE
  • NPI 1457487696
  NPD (past)

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

{
    "created_epoch": "1172275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684972800000",
    "number": "1992831135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 S 66TH ST",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685102302",
            "telephone_number": "402-489-9776",
            "fax_number": "402-489-9946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17255 DAVENPORT ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681184092",
            "telephone_number": "402-763-6466"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17660 Wright St Ste 18",
            "address_purpose": "LOCATION",
            "city": "Omaha",
            "state": "NE",
            "postal_code": "681302899",
            "country_code": "US",
            "telephone_number": "402-991-0160",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JIMMY",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-24",
        "last_updated": "2023-05-25",
        "certification_date": "2023-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NE",
            "license": "847",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "6967",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica L Johnson, LPN
• Jessy Johnson
• Jillian Johnson
• Jillian Blair Johnson
• Jimmy Johnson
• Jo Anna Johnson
• Joeanna L Johnson
• Joni Johnson
• Jordan Johnson
• Jordan D Johnson

• Optometrist in Omaha, NE
• Providers in Omaha, NE by specialty
• Optometrist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2023; 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.