Provider Demographics
NPI:1447284344
Name:JOHANSSON, JOHN OLAF (MD PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:OLAF
Last Name:JOHANSSON
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2981 OLIVE HWY
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-6109
Mailing Address - Country:US
Mailing Address - Phone:530-533-4500
Mailing Address - Fax:530-533-5643
Practice Address - Street 1:2809 OLIVE HWY
Practice Address - Street 2:SUITE 140
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966
Practice Address - Country:US
Practice Address - Phone:530-534-1400
Practice Address - Fax:530-534-6380
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46646207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A466460OtherBLUE SHIELD
CA00A466460OtherBLUE CROSS
CA00A466460Medicaid
CA00A466460OtherBLUE CROSS
CAE64323Medicare UPIN
CA00A466460OtherBLUE SHIELD
CA180034540Medicare PIN