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General NPI Number Information
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NPI Number | 1356507891
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Entity Type | Individual
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Provider Name | CHRISTINE M MIKOLAJ O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 129 N CHALKVILLE RD
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City | TRUSSVILLE
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State | AL
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Zip | 35173-1376
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Country | US
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Telephone | 205-661-2080
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Fax | 205-661-2085
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Provider Business Mailing Address
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Address Line | PO BOX 1310
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City | TRUSSVILLE
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State | AL
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Zip | 35173-6102
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Country | US
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Telephone | 205-661-2080
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Fax | 205-661-2085
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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 | R-182-TA-821
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License Number State | AL
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