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General NPI Number Information
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NPI Number | 1649778507
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Entity Type | Organization
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Legal Business Name | CHRISTOPHER D. JOHNSON OD, PC
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Dates
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Enumeration Date | 01/25/2018
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Last Update Date | 01/25/2018
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Provider Practice Location Address
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Address Line | 617 CLAY ST E
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City | MONMOUTH
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State | OR
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Zip | 97361-2402
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Country | US
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Telephone | 503-623-3538
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Fax | 503-623-8112
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Provider Business Mailing Address
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Address Line | 986 SE UGLOW AVE
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City | DALLAS
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State | OR
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Zip | 97338-2643
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Country | US
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Telephone | 503-623-3538
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Fax | 503-623-8112
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTOPHER DAVID JOHNSON
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Credential | OD, PC
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Telephone | 503-623-3538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2925ATI
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License Number State | OR
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