Provider Demographics
NPI:1164580643
Name:EYECARE ASSOCIATES OF WEST RICHLAND
Entity Type:Organization
Organization Name:EYECARE ASSOCIATES OF WEST RICHLAND
Other - Org Name:CHRISTOPHER D JOHNSON, OD PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST OWNER MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-967-1503
Mailing Address - Street 1:4476 W VAN GIESEN ST
Mailing Address - Street 2:SUITE NUMBER B
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-5411
Mailing Address - Country:US
Mailing Address - Phone:509-967-1503
Mailing Address - Fax:509-967-1768
Practice Address - Street 1:4476 W VAN GIESEN ST
Practice Address - Street 2:SUITE NUMBER B
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-5411
Practice Address - Country:US
Practice Address - Phone:509-967-1503
Practice Address - Fax:509-967-1768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD3817152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8801650Medicare PIN
WAG8801648Medicare PIN
WAU95912Medicare UPIN