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General NPI Number Information
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NPI Number | 1659460848
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Entity Type | Individual
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Provider Name | JOHN SCHROLUCKE O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 5140 W PEORIA AVE STE. 116
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City | GLENDALE
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State | AZ
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Zip | 85302-1630
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Country | US
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Telephone | 623-487-1100
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Fax | 623-487-1417
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Provider Business Mailing Address
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Address Line | 5140 W PEORIA AVE STE. 116
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City | GLENDALE
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State | AZ
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Zip | 85302-1630
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Country | US
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Telephone | 623-487-1100
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Fax | 623-487-1417
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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 | AZ0212
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License Number State | AZ
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