Provider Demographics
NPI:1902625932
Name:JOHNSON FAMILY VISION INC.
Entity type:Organization
Organization Name:JOHNSON FAMILY VISION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-345-4912
Mailing Address - Street 1:3100 MERIDIAN PARKET DR
Mailing Address - Street 2:SUITE J
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-9424
Mailing Address - Country:US
Mailing Address - Phone:317-888-9755
Mailing Address - Fax:317-888-9768
Practice Address - Street 1:3100 MERIDIAN PARKET DR
Practice Address - Street 2:SUITE J
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-9424
Practice Address - Country:US
Practice Address - Phone:317-888-9755
Practice Address - Fax:317-888-9768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01267559OtherRAIL ROAD RETIREES