Provider Demographics
NPI:1366517989
Name:CHRISTOPHER D. JOHNSON OD, PC
Entity type:Organization
Organization Name:CHRISTOPHER D. JOHNSON OD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-623-3538
Mailing Address - Street 1:986 SE UGLOW ST.
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338
Mailing Address - Country:US
Mailing Address - Phone:503-623-3538
Mailing Address - Fax:503-623-8112
Practice Address - Street 1:986 SE UGLOW ST.
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338
Practice Address - Country:US
Practice Address - Phone:503-623-3538
Practice Address - Fax:503-623-8112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2925ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC770OtherMEDICARE RAILROAD
212606OtherEYEMED
OR298499Medicaid
212606OtherEYEMED
OR5393130001Medicare NSC
212606OtherEYEMED
OR298499Medicaid
ORR119427Medicare ID - Type Unspecified