Provider Demographics
NPI:1679639983
Name:DOWNING, JOHN CHARLES (OD PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:DOWNING
Suffix:
Gender:M
Credentials:OD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 GRANDVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-2901
Mailing Address - Country:US
Mailing Address - Phone:707-829-1478
Mailing Address - Fax:707-829-3444
Practice Address - Street 1:720 GRANDVIEW RD
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-2901
Practice Address - Country:US
Practice Address - Phone:707-829-1478
Practice Address - Fax:707-829-3444
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT4981TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
9841OtherPIN
CA0049810Medicaid
CA0049810Medicaid