Provider Demographics
NPI:1447392519
Name:JOHNS, HERBERT H (OD)
Entity type:Individual
Prefix:
First Name:HERBERT
Middle Name:H
Last Name:JOHNS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 WICKSHIRE CT SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-6418
Mailing Address - Country:US
Mailing Address - Phone:503-361-3870
Mailing Address - Fax:503-361-3865
Practice Address - Street 1:4885 27TH AVE SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-6919
Practice Address - Country:US
Practice Address - Phone:503-361-3870
Practice Address - Fax:503-361-3865
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2781ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORV06349Medicare UPIN