Provider Demographics
NPI:1659371094
Name:JOHNSTON, JAMES P
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 SAINT JOHN RD
Mailing Address - Street 2:STE 404
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-7354
Mailing Address - Country:US
Mailing Address - Phone:219-874-7236
Mailing Address - Fax:
Practice Address - Street 1:450 SAINT JOHN RD
Practice Address - Street 2:STE 404
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7354
Practice Address - Country:US
Practice Address - Phone:219-874-7236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5001000030156FX1700X
ILDEPARTMENT OF LABOR156FX1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1123610001Medicare NSC