Provider Demographics
NPI:1043691959
Name:JOHNSTON, LISA C (BCO, BADO)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:BCO, BADO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7476 OLD FAIRGROUND RD
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-6105
Mailing Address - Country:US
Mailing Address - Phone:919-207-2515
Mailing Address - Fax:919-894-1335
Practice Address - Street 1:7476 OLD FAIRGROUND RD
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-6105
Practice Address - Country:US
Practice Address - Phone:919-207-2515
Practice Address - Fax:919-894-1335
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
No174400000XOther Service ProvidersSpecialist