MEDICARE: CHRISTOPHER D. JOHNSON OD, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2925ATI	OR

General Provider Information

NPI Number	:	1649778507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTOPHER D. JOHNSON OD, PC

Provider Business Mailing Address
First Line	:	986 SE UGLOW AVE
Second Line	:
City	:	DALLAS
State	:	OR
Zip	:	97338-2643
Country	:	US
Telephone Number	:	503-623-3538
Fax Number	:	503-623-8112

Provider Business Practice Location Address
First Line	:	617 CLAY ST E
Second Line	:
City	:	MONMOUTH
State	:	OR
Zip	:	97361-2402
Country	:	US
Telephone Number	:	503-623-3538
Fax Number	:	503-623-8112

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHRISTOPHER DAVID JOHNSON
Credential	:	OD, PC
Telephone Number	:	503-623-3538

Provider Enumeration Date	:	01/25/2018
Last Update Date	:	01/25/2018

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