NPIMap

Organization Active NPI

Christopher D. Johnson OD, PC

Doing business as Mid-Valley Eyecare

  • Optometrist
  • Dallas, OR
National Provider Identifier
1366517989
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2925ATI Issued in OR
Legal business name
CHRISTOPHER D. JOHNSON OD, PC
Doing business as
Mid-Valley Eyecare
Practice address
986 SE Uglow St.
Dallas, OR 97338
Phone
(503) 623-3538
Fax
(503) 623-8112
NPI assigned
Nov 21, 2006
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Christopher David Johnson, O.D.NPI 1740383116
Title
Doctor of Optometry Owner
Phone
(503) 623-3538

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2925ATI OR Primary

Addresses

Primary practice location

986 SE Uglow St.
Dallas, OR 97338

Mailing address

986 SE Uglow St.
Dallas, OR 97338
Phone (503) 623-3538

Other identifiers 3

IdentifierTypeStateIssuer
212606OtherEYEMED
298499MedicaidOR
DC770OtherMEDICARE RAILROAD

Other names 1

  • Mid-Valley Eyecare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040714000475 OR Part B Supplier - Clinic/Group Practice 7517946650 Receives reassigned benefits from 4 practitioners
Practice locations: Monmouth, OR; Dallas, OR
O20100930099600 OR DME Supplier - Physician - Optometrist 7517946650 Practice locations: Dallas, OR

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Mid Valley Eyecare986 SE Uglow Ave, Dallas, OR 97338-2643(503) 623-3538 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jan 15, 2005

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1366517989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "986 SE UGLOW ST.",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "97338",
            "telephone_number": "503-623-3538",
            "fax_number": "503-623-8112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "986 SE UGLOW ST.",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "97338",
            "telephone_number": "503-623-3538",
            "fax_number": "503-623-8112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTOPHER D. JOHNSON OD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2008-04-20",
        "status": "A",
        "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",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "2925ATI",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "212606",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "298499",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DC770",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mid-Valley Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dallas, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.