Provider Demographics
NPI:1568501625
Name:JOHNSTON, ROBERT CULLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CULLEN
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 1:4598 AVENIDA MANESSA
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-7745
Mailing Address - Country:US
Mailing Address - Phone:760-631-2877
Mailing Address - Fax:
Practice Address - Street 1:705 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-6259
Practice Address - Country:US
Practice Address - Phone:760-631-2877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10220T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist