Healthcare Provider Details

I. General information

NPI: 1285997924
Provider Name (Legal Business Name): CASEY JOHNSTON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9475 BRIAR VILLAGE PT STE 200
COLORADO SPRINGS CO
80920-7918
US

IV. Provider business mailing address

9475 BRIAR VILLAGE PT STE 200
COLORADO SPRINGS CO
80920-7918
US

V. Phone/Fax

Practice location:
  • Phone: 719-594-2020
  • Fax: 719-694-8562
Mailing address:
  • Phone: 719-594-2020
  • Fax: 719-694-8562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7967TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: