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General NPI Number Information
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NPI Number | 1538106984
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Entity Type | Organization
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Legal Business Name | JOHN J. MILEKE, OD, INC.
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 801 S CHEVY CHASE DR #103
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City | GLENDALE
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State | CA
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Zip | 91205-4431
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Country | US
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Telephone | 818-265-2246
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Fax |
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Provider Business Mailing Address
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Address Line | 801 S CHEVY CHASE DR #103
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City | GLENDALE
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State | CA
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Zip | 91205-4431
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Country | US
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Telephone | 818-265-2246
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN J. MIELKE
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Credential | OD
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Telephone | 818-265-2246
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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 |
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License Number State |
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