Healthcare Provider Details

I. General information

NPI: 1831161744
Provider Name (Legal Business Name): DANIEL P. JOHNSTON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 PAOLI PIKE
WEST CHESTER PA
19380-4527
US

IV. Provider business mailing address

122 WOODMINT DR
WEST CHESTER PA
19380-2102
US

V. Phone/Fax

Practice location:
  • Phone: 610-692-8300
  • Fax: 610-692-6007
Mailing address:
  • Phone: 813-597-8147
  • Fax: 610-692-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC 3715
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001893
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: