Provider Demographics
NPI:1649276866
Name:JOHNSON, PATRICK ANTHONY (O D)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:ANTHONY
Last Name:JOHNSON
Suffix:
Gender:
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3458 NEELY RD
Mailing Address - Street 2:
Mailing Address - City:JOINT BASE MDL
Mailing Address - State:NJ
Mailing Address - Zip Code:08641-5312
Mailing Address - Country:US
Mailing Address - Phone:609-754-9685
Mailing Address - Fax:609-754-9417
Practice Address - Street 1:3458 NEELY RD
Practice Address - Street 2:
Practice Address - City:JOINT BASE MDL
Practice Address - State:NJ
Practice Address - Zip Code:08641-5312
Practice Address - Country:US
Practice Address - Phone:609-754-9685
Practice Address - Fax:609-754-9417
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA00547400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2143321OtherAETNA
NJ2236448790OtherHORIZON BC/BS OF NJ
NJ223644879OtherWPS TRICARE FOR LIFE
NJ223644879OtherTRICARE
NJ211097OtherUSFHP
NJ2143309OtherAETNA
NJ083615Medicare ID - Type UnspecifiedNEW # ASSIGNED
NJ223644879OtherTRICARE
NJ004170Medicare ID - Type UnspecifiedOLD ASSIGNED #