MEDICARE: JODIE J 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	963300949934	UT
2	152WC0802X	Corneal and Contact Management Optometrist	330094-9934	UT
3	152WL0500X	Low Vision Rehabilitation Optometrist	3300949934	UT
4	152WP0200X	Pediatric Optometrist	330094-9934	UT
5	152WS0006X	Sports Vision Optometrist	330094-9934	UT
6	152WV0400X	Vision Therapy Optometrist	330094-9934	UT
7	152WX0102X	Occupational Vision Optometrist	330094-9934	UT

General Provider Information

NPI Number	:	1629001474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODIE J JOHNSON O.D.

Provider Business Mailing Address
First Line	:	2364 W 12600 S
Second Line	:	SUITE E
City	:	RIVERTON
State	:	UT
Zip	:	84065-7109
Country	:	US
Telephone Number	:	801-446-7600
Fax Number	:	801-446-0912

Provider Business Practice Location Address
First Line	:	2364 W 12600 S
Second Line	:	SUITE E
City	:	RIVERTON
State	:	UT
Zip	:	84065-7109
Country	:	US
Telephone Number	:	801-446-7600
Fax Number	:	801-446-0912

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	09/11/2025

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