Provider Demographics
NPI:1487750683
Name:JOHNSON CURRAN OPTOMETRY CENTERS PC
Entity type:Organization
Organization Name:JOHNSON CURRAN OPTOMETRY CENTERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:540-362-7565
Mailing Address - Street 1:5049 VALLEY VIEW BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-2074
Mailing Address - Country:US
Mailing Address - Phone:540-362-7565
Mailing Address - Fax:540-563-0441
Practice Address - Street 1:5049 VALLEY VIEW BLVD NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-2074
Practice Address - Country:US
Practice Address - Phone:540-362-7565
Practice Address - Fax:540-563-0441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2025-03-06
Deactivation Date:2025-03-04
Deactivation Code:
Reactivation Date:2025-03-06
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1487750683Medicaid
VA0637850001Medicare NSC
VA1487750683Medicaid