MEDICARE: DR. PHILIP ALAN MISCHENKO O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	7015T	CA

General Provider Information

NPI Number	:	1194860270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP ALAN MISCHENKO O.D.

Provider Business Mailing Address
First Line	:	1848 STONEHOUSE RD
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91006-1622
Country	:	US
Telephone Number	:	626-355-1543
Fax Number	:	626-286-9214

Provider Business Practice Location Address
First Line	:	5825 TEMPLE CITY BLVD
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-2113
Country	:	US
Telephone Number	:	626-286-9214
Fax Number	:	626-296-9231

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/08/2007

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