Healthcare Provider Details

I. General information

NPI: 1538106984
Provider Name (Legal Business Name): JOHN J. MILEKE, OD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S CHEVY CHASE DR #103
GLENDALE CA
91205-4431
US

IV. Provider business mailing address

801 S CHEVY CHASE DR #103
GLENDALE CA
91205-4431
US

V. Phone/Fax

Practice location:
  • Phone: 818-265-2246
  • Fax:
Mailing address:
  • Phone: 818-265-2246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: JOHN J. MIELKE
Title or Position: PRESIDENT
Credential: OD
Phone: 818-265-2246