Provider Demographics
NPI:1851398168
Name:JOHNSTON, MARK EDMUND (MD FRCSC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDMUND
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MD FRCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13330 N 74TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-1919
Mailing Address - Country:US
Mailing Address - Phone:026-393-2504
Mailing Address - Fax:402-397-7967
Practice Address - Street 1:13330 N 74TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1919
Practice Address - Country:US
Practice Address - Phone:402-639-3250
Practice Address - Fax:402-387-7967
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA31743207W00000X
NE20412207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE268924Medicare ID - Type Unspecified
IAB46748Medicare UPIN
IAI7885Medicare ID - Type Unspecified