Provider Demographics
NPI:1154398824
Name:JOHNSTON, RICHARD H (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6525 FRANCE AVE S
Mailing Address - Street 2:SUITE 115
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2148
Mailing Address - Country:US
Mailing Address - Phone:952-345-8200
Mailing Address - Fax:952-345-8207
Practice Address - Street 1:6525 FRANCE AVE S
Practice Address - Street 2:SUITE 115
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2148
Practice Address - Country:US
Practice Address - Phone:952-345-8200
Practice Address - Fax:952-345-8207
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN45559207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34379300Medicaid
MN180001120Medicare ID - Type Unspecified
WI34379300Medicaid