MEDICARE: DR. DAVID R JOHNSTON OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0618000069	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477546091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID R JOHNSTON OD

Provider Business Mailing Address
First Line	:	3900 MONUMENT AVE
Second Line	:	SUITE D
City	:	RICHMOND
State	:	VA
Zip	:	23230-3902
Country	:	US
Telephone Number	:	804-358-2191
Fax Number	:	804-358-7542

Provider Business Practice Location Address
First Line	:	3900 MONUMENT AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-3902
Country	:	US
Telephone Number	:	804-358-2191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	09/11/2008

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