Provider Demographics
NPI:1619317153
Name:JOHNSTON, LIAN PHETPHOUVONG (OD)
Entity Type:Individual
Prefix:
First Name:LIAN
Middle Name:PHETPHOUVONG
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 W MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-3805
Mailing Address - Country:US
Mailing Address - Phone:559-582-9288
Mailing Address - Fax:
Practice Address - Street 1:202 W MYRTLE ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3805
Practice Address - Country:US
Practice Address - Phone:559-582-9288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14664152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist