MEDICARE: DR. HOWARD MISHELOFF, 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	5570TPL	CA

General Provider Information

NPI Number	:	1659606341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. HOWARD MISHELOFF, O.D.

Provider Business Mailing Address
First Line	:	8363 RESEDA BLVD
Second Line	:	SUITE 12
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-4623
Country	:	US
Telephone Number	:	818-349-1015
Fax Number	:	818-349-9078

Provider Business Practice Location Address
First Line	:	8363 RESEDA BLVD
Second Line	:	SUITE 12
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-4623
Country	:	US
Telephone Number	:	818-349-1015
Fax Number	:	818-349-9078

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. REBECCA MISHELOFF
Credential	:
Telephone Number	:	818-349-1015

Provider Enumeration Date	:	10/13/2009
Last Update Date	:	03/19/2010

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