Provider Demographics
NPI:1568467207
Name:JOHNSON VISION CARE, INC.
Entity type:Organization
Organization Name:JOHNSON VISION CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:609-261-9001
Mailing Address - Street 1:201 CREEK CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:HAINESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036-2766
Mailing Address - Country:US
Mailing Address - Phone:609-261-9001
Mailing Address - Fax:609-261-9005
Practice Address - Street 1:201 CREEK CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:HAINESPORT
Practice Address - State:NJ
Practice Address - Zip Code:08036-2766
Practice Address - Country:US
Practice Address - Phone:609-261-9001
Practice Address - Fax:609-261-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-18
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA00547400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2143309OtherAETNA
NJ211097OtherUSFHP
NJ2143321OtherAETNA
NJ=========OtherTRICARE
NJ=========OtherWPS TRICARE FOR LIFE
NJ2143321OtherAETNA
NJ2143309OtherAETNA
NJ2143321OtherAETNA
NJU68681Medicare UPIN