Provider Demographics
NPI:1083701544
Name:DRAGON, JOHN CHRISTOPHER (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHRISTOPHER
Last Name:DRAGON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7525 TIDEWATER DR
Mailing Address - Street 2:SUITE 41
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-3700
Mailing Address - Country:US
Mailing Address - Phone:757-588-5423
Mailing Address - Fax:757-588-6012
Practice Address - Street 1:7525 TIDEWATER DR
Practice Address - Street 2:SUITE 41
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-3700
Practice Address - Country:US
Practice Address - Phone:757-588-5423
Practice Address - Fax:757-588-6012
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000040152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9234462Medicaid
VA0322710001Medicare NSC
VA32849Medicare UPIN
VA9234462Medicaid