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General NPI Number Information
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NPI Number | 1992766646
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Entity Type | Individual
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Provider Name | JOHN J. MIELKE O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 801 S CHEVY CHASE DR SUITE 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 | PO BOX 127
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City | NAPA
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State | CA
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Zip | 94559-0127
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Country | US
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Telephone | 707-255-3300
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Fax | 707-255-3527
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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 | 10377
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License Number State | CA
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