Provider Demographics
NPI:1285928622
Name:JAMES C JOHNSON, OD, LLC
Entity type:Organization
Organization Name:JAMES C JOHNSON, OD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-705-3937
Mailing Address - Street 1:1800 E HIGH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3239
Mailing Address - Country:US
Mailing Address - Phone:610-705-3937
Mailing Address - Fax:610-705-3903
Practice Address - Street 1:1800 E HIGH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3239
Practice Address - Country:US
Practice Address - Phone:610-705-3937
Practice Address - Fax:610-705-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG-1758152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2229590000OtherIBC/KEYSTONE
PAOEG-1758OtherSTATE LICENSE
PAT30277Medicare UPIN
DT0964Medicare PIN
PAOEG-1758OtherSTATE LICENSE