Provider Demographics
NPI:1841995594
Name:JOHNSON, CHRYSTAL LYNN
Entity type:Individual
Prefix:MRS
First Name:CHRYSTAL
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CHRYSTAL
Other - Middle Name:L
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1027 HODGES DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-2856
Mailing Address - Country:US
Mailing Address - Phone:614-593-9730
Mailing Address - Fax:
Practice Address - Street 1:1693 STRINGTOWN RD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-8265
Practice Address - Country:US
Practice Address - Phone:614-539-8640
Practice Address - Fax:614-539-8644
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOP.010042-SC156FX1800X
OHOP.010042.SC156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty