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General NPI Number Information
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NPI Number | 1376247486
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Entity Type | Organization
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Legal Business Name | S. JOHNSTON, OD PLLC
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Dates
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Enumeration Date | 03/30/2023
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 3220 N RESERVE ST
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City | MISSOULA
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State | MT
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Zip | 59808-1556
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Country | US
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Telephone | 406-218-2730
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Fax | 406-218-2731
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Provider Business Mailing Address
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Address Line | 2421 HALF HITCH DR
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City | MISSOULA
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State | MT
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Zip | 59808-5472
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Country | US
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Telephone | 623-688-7310
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | SHANE JOHNSTON
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Credential | OD
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Telephone | 623-688-7310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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