Healthcare Provider Details

I. General information

NPI: 1841474731
Provider Name (Legal Business Name): DONALD J JOHNSON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 02/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 WASHBURN WAY
KLAMATH FALLS OR
97603-4539
US

IV. Provider business mailing address

PO BOX 759
ASHLAND OR
97520-0026
US

V. Phone/Fax

Practice location:
  • Phone: 541-883-1669
  • Fax:
Mailing address:
  • Phone: 541-488-1417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1642 ATI
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1642 ATI
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number1642ATI
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number1642ATI
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: