Healthcare Provider Details

I. General information

NPI: 1811730294
Provider Name (Legal Business Name): MIKAYLA MARIE CREE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 RUSTIC LODGE RD
INDIANA PA
15701-3472
US

IV. Provider business mailing address

626 S PINE ST
ALTOONA PA
16602-5787
US

V. Phone/Fax

Practice location:
  • Phone: 724-463-8882
  • Fax:
Mailing address:
  • Phone: 814-505-8022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG004170
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: