Provider Demographics
NPI:1447392519
Name:JOHNS, HERBERT H (OD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:H
Last Name:JOHNS
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 1:1522 REVERE CT S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2413
Mailing Address - Country:US
Mailing Address - Phone:503-371-7887
Mailing Address - Fax:503-361-3830
Practice Address - Street 1:1010 HAWTHORNE AVE SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-5090
Practice Address - Country:US
Practice Address - Phone:503-371-7887
Practice Address - Fax:503-361-3830
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2781ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORV06349Medicare UPIN