Dr. Robert John Johnson, O.D.
Optometrist in Coeur D Alene, ID. Individual provider (NPI-1).
NPI number1265484604
StatusActive
Last updated in NPPESOct 21, 2010
Details
- NPI
- 1265484604
- Entity type
- Individual (NPI-1)
- Name
- Dr. Robert John Johnson
- Credential
- O.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 16, 2006
- Last updated
- Oct 21, 2010
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - OPTOMETRY
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility No · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | 1000020 | ID | Yes |
| 152W00000X | Optometrist | OD00003408 | WA |
Practice location
1801 N 3rd StCoeur D Alene, ID 83814-3400
Phone 208-667-1591 · Fax 208-676-8574
Mailing address
1801 N 3rd StCoeur D Alene, ID 83814-3400
Phone 208-667-1591 · Fax 208-676-8574
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 19 Optometrist providers in Coeur D Alene · All 2,988 providers in Coeur D Alene
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