1366517989 NPI number — CHRISTOPHER D. JOHNSON OD, PC

Table of content: DR. JENNIFER LISA SAYANLAR D.O. (NPI 1073779666)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366517989 NPI number — CHRISTOPHER D. JOHNSON OD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTOPHER D. JOHNSON OD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366517989
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
986 SE UGLOW ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-623-3538
Provider Business Mailing Address Fax Number:
503-623-8112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
986 SE UGLOW ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-623-3538
Provider Business Practice Location Address Fax Number:
503-623-8112
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
DOCTOR OF OPTOMETRY OWNER
Authorized Official Telephone Number:
503-623-3538

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2925ATI , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DC770 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 212606 . This is a "EYEMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 298499 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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