1598883423 NPI number — JIM A. JOHNSON, O.D., P.A.

Table of content: (NPI 1598883423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598883423 NPI number — JIM A. JOHNSON, O.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JIM A. JOHNSON, O.D., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598883423
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1820 S OHIO ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALINA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67401-6607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-827-1010
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1820 S OHIO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALINA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67401-6607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-827-1010
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
JIM
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
785-827-1010

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1354-3 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1354-3 . This is a "KANSAS LICENSE OPTOMETRY" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 0000651148 . This is a "BLUE CROSS BLUESHIELD KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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