Healthcare Provider Details

I. General information

NPI: 1427017490
Provider Name (Legal Business Name): MICHAEL JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 THOMAS INDIAN SCHOOL DR
IRVING NY
14081-9341
US

IV. Provider business mailing address

987 R C HOAG DR
SALAMANCA NY
14779-1365
US

V. Phone/Fax

Practice location:
  • Phone: 716-532-5582
  • Fax: 716-242-6344
Mailing address:
  • Phone: 716-945-5894
  • Fax: 716-242-6345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number192833-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: