Provider Demographics
NPI:1114916053
Name:JOHNSTON, ERIC WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:WILLIAM
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 UNION ST UNIT 1103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-3445
Mailing Address - Country:US
Mailing Address - Phone:312-498-4301
Mailing Address - Fax:
Practice Address - Street 1:477 N EL CAMINO REAL STE C202
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1332
Practice Address - Country:US
Practice Address - Phone:760-631-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102349207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK19781/203980OtherRAILROAD MEDICARE
IL180042222OtherRAILROAD MEDICARE
ILP00260020/CK6882OtherDMERC
IL036102349Medicaid
ILK197778/203979OtherRAILROAD MEDICARE
ILG95989Medicare UPIN
IL036102349Medicaid
IL705490Medicare PIN