MEDICARE: DAVID JOHNSTON, O.D.

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

General Provider Information

NPI Number	:	1649421827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID JOHNSTON, O.D.

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

Authorized Official
Title or Position	:	O.D.
Name	:	DR. DAVID R. JOHNSTON
Credential	:
Telephone Number	:	804-358-2191

Provider Enumeration Date	:	10/06/2008
Last Update Date	:	10/06/2008

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