MEDICARE: DR. TAMMRA ROESENER JOHNSON O.D.

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	1292	CO
2	152WC0802X	Corneal and Contact Management Optometrist	1292	CO
3	152WP0200X	Pediatric Optometrist	1292	CO
4	152WV0400X	Vision Therapy Optometrist	1292	CO

General Provider Information

NPI Number	:	1144439712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAMMRA ROESENER JOHNSON O.D.

Provider Business Mailing Address
First Line	:	412 REMINGTON ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-2911
Country	:	US
Telephone Number	:	970-482-4700
Fax Number	:	970-482-0966

Provider Business Practice Location Address
First Line	:	412 REMINGTON ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-2911
Country	:	US
Telephone Number	:	970-482-4700
Fax Number	:	970-482-0966

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	09/11/2025

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