Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | OPT1684 | CO |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OPT1684 | CO |
N | 152WP0200X | Pediatric Optomitrist | OPT1684 | CO |
N | 152WV0400X | Optomitrist - Vision Therapist | OPT1684 | CO |
N | 152WX0102X | Occupational Vision | OPT1684 | CO |
NPI | 1013040542 |
---|---|
Provider Name | Monique Rene' Mikula |
First Address | Greeley, CO 80634-2545 |
Second Address | Greeley, CO 80634-2545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U66214 | (02) | CO |