Provider Demographics
NPI:1548315476
Name:JOHNSTON, DONALD S (OD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:S
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1822
Mailing Address - Country:US
Mailing Address - Phone:732-741-0170
Mailing Address - Fax:732-741-2808
Practice Address - Street 1:41 E FRONT ST
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1822
Practice Address - Country:US
Practice Address - Phone:732-741-0170
Practice Address - Fax:732-741-2808
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00343400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0353670001OtherDME ID NUMBER
NJ0353670001OtherDME ID NUMBER