1164580643 NPI number — EYECARE ASSOCIATES OF WEST RICHLAND

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164580643 NPI number — EYECARE ASSOCIATES OF WEST RICHLAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYECARE ASSOCIATES OF WEST RICHLAND
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:
CHRISTOPHER D JOHNSON, OD PLLC
Provider Other Organization Name Type Code:
3
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:
1164580643
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4476 W VAN GIESEN ST
Provider Second Line Business Mailing Address:
SUITE NUMBER B
Provider Business Mailing Address City Name:
WEST RICHLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99353-5411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-967-1503
Provider Business Mailing Address Fax Number:
509-967-1768

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4476 W VAN GIESEN ST
Provider Second Line Business Practice Location Address:
SUITE NUMBER B
Provider Business Practice Location Address City Name:
WEST RICHLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99353-5411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-967-1503
Provider Business Practice Location Address Fax Number:
509-967-1768
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
OPTOMETRIST OWNER MEMBER
Authorized Official Telephone Number:
509-967-1503

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OD3817 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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