Healthcare Provider Details

I. General information

NPI: 1124345756
Provider Name (Legal Business Name): JOHN STOLPE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOHN STOLPE

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18455 BURBANK BLVD STE 202
TARZANA CA
91356-6627
US

IV. Provider business mailing address

18455 BURBANK BLVD STE 202
TARZANA CA
91356-6627
US

V. Phone/Fax

Practice location:
  • Phone: 818-758-1666
  • Fax: 818-758-1786
Mailing address:
  • Phone: 818-758-1666
  • Fax: 818-758-1786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number09-336-15
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: