Provider Demographics
NPI:1699974477
Name:JOHNSTON, AMANDA LYN (OD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LYN
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:120 PALUSTER ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-2532
Mailing Address - Country:US
Mailing Address - Phone:231-775-7341
Mailing Address - Fax:231-775-3925
Practice Address - Street 1:120 PALUSTER ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2532
Practice Address - Country:US
Practice Address - Phone:231-775-7341
Practice Address - Fax:231-775-3925
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004438152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist