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NPI Code Detail

MEDICARE: DR. PATRICK ANTHONY JOHNSON O. D.

MEDICARE: DR. PATRICK ANTHONY 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
1152W00000XOptometristOA00547400NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12143321OTHERNJAETNA
22236448790OTHERNJHORIZON BC/BS OF NJ
3223644879OTHERNJWPS TRICARE FOR LIFE
4223644879OTHERNJTRICARE
5211097OTHERNJUSFHP
62143309OTHERNJAETNA

General Provider Information

NPI Number : 1649276866
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PATRICK ANTHONY JOHNSON O. D.
Provider Business Mailing Address
First Line : 3458 NEELY RD
Second Line :
City : JOINT BASE MDL
State : NJ
Zip : 08641-5312
Country : US
Telephone Number : 609-754-9685
Fax Number : 609-754-9417
Provider Business Practice Location Address
First Line : 3458 NEELY RD
Second Line :
City : JOINT BASE MDL
State : NJ
Zip : 08641-5312
Country : US
Telephone Number : 609-754-9685
Fax Number : 609-754-9417
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2005
Last Update Date : 02/24/2025

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