Provider Demographics
NPI:1427078468
Name:JOHNSTON, JAY CARTER II (O D)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:CARTER
Last Name:JOHNSTON
Suffix:II
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 W MEMORIAL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-9350
Mailing Address - Country:US
Mailing Address - Phone:405-749-4280
Mailing Address - Fax:405-749-4281
Practice Address - Street 1:4200 W MEMORIAL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9350
Practice Address - Country:US
Practice Address - Phone:405-749-4280
Practice Address - Fax:405-749-4281
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2274152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU76968Medicare UPIN
OK730800796Medicare ID - Type UnspecifiedMEDICARE