Provider Demographics
NPI:1477546091
Name:JOHNSTON, DAVID R (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 MONUMENT AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3902
Mailing Address - Country:US
Mailing Address - Phone:804-358-2191
Mailing Address - Fax:804-358-7542
Practice Address - Street 1:3900 MONUMENT AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3902
Practice Address - Country:US
Practice Address - Phone:804-358-2191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000069152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9201581Medicaid
VA9201581Medicaid
T21775Medicare UPIN