Provider Demographics
NPI:1679589832
Name:JOHNSON, CHRISTOPHER DANIEL (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DANIEL
Last Name:JOHNSON
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 1:473 S 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-5166
Mailing Address - Country:US
Mailing Address - Phone:509-967-1503
Mailing Address - Fax:509-967-1768
Practice Address - Street 1:473 S 38TH AVE
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-5166
Practice Address - Country:US
Practice Address - Phone:509-967-1503
Practice Address - Fax:509-967-1768
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003817152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU95912Medicare UPIN
WAG8801648Medicare PIN