Provider Demographics
NPI:1649778507
Name:CHRISTOPHER D. JOHNSON OD, PC
Entity Type:Organization
Organization Name:CHRISTOPHER D. JOHNSON OD, PC
Other - Org Name:MID VALLEY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD, PC
Authorized Official - Phone:503-623-3538
Mailing Address - Street 1:986 SE UGLOW AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-2643
Mailing Address - Country:US
Mailing Address - Phone:503-623-3538
Mailing Address - Fax:503-623-8112
Practice Address - Street 1:617 CLAY ST E
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:OR
Practice Address - Zip Code:97361-2402
Practice Address - Country:US
Practice Address - Phone:503-623-3538
Practice Address - Fax:503-623-8112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2925ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty