MEDICARE: JOHNSON VISION CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OA00547400	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2143309	OTHER	NJ	AETNA
2	211097	OTHER	NJ	USFHP
3	2143321	OTHER	NJ	AETNA

General Provider Information

NPI Number	:	1568467207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNSON VISION CARE, INC.

Provider Business Mailing Address
First Line	:	201 CREEK CROSSING BLVD
Second Line	:
City	:	HAINESPORT
State	:	NJ
Zip	:	08036-2766
Country	:	US
Telephone Number	:	609-261-9001
Fax Number	:	609-261-9005

Provider Business Practice Location Address
First Line	:	201 CREEK CROSSING BLVD
Second Line	:
City	:	HAINESPORT
State	:	NJ
Zip	:	08036-2766
Country	:	US
Telephone Number	:	609-261-9001
Fax Number	:	609-261-9005

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PATRICK ANTHONY JOHNSON
Credential	:	O. D.
Telephone Number	:	609-261-9001

Provider Enumeration Date	:	06/18/2005
Last Update Date	:	10/14/2009

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Directions to “JOHNSON VISION CARE, INC. ” Practice Location

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