Provider Demographics
NPI:1447827142
Name:JOHNSTON, NOELLE
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02828-1767
Mailing Address - Country:US
Mailing Address - Phone:401-949-1616
Mailing Address - Fax:401-942-0952
Practice Address - Street 1:12 SMITH AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:RI
Practice Address - Zip Code:02828-1767
Practice Address - Country:US
Practice Address - Phone:401-949-1616
Practice Address - Fax:401-942-0952
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICODTG00712152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty