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General NPI Number Information
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NPI Number | 1194860270
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Entity Type | Individual
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Provider Name | PHILIP ALAN MISCHENKO O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5825 TEMPLE CITY BLVD
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City | TEMPLE CITY
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State | CA
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Zip | 91780-2113
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Country | US
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Telephone | 626-286-9214
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Fax | 626-296-9231
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Provider Business Mailing Address
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Address Line | 1848 STONEHOUSE RD
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City | ARCADIA
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State | CA
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Zip | 91006-1622
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Country | US
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Telephone | 626-355-1543
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Fax | 626-286-9214
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 7015T
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License Number State | CA
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