Healthcare Provider Details

I. General information

NPI: 1154398824
Provider Name (Legal Business Name): RICHARD H JOHNSTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 FRANCE AVE S SUITE 115
EDINA MN
55435-2148
US

IV. Provider business mailing address

6525 FRANCE AVE S SUITE 115
EDINA MN
55435-2148
US

V. Phone/Fax

Practice location:
  • Phone: 952-345-8200
  • Fax: 952-345-8207
Mailing address:
  • Phone: 952-345-8200
  • Fax: 952-345-8207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number45559
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number45559
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: