Individual
DR. JAMES L MIKKELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3405 SPENCER HWY, PASADENA, TX 77504-1107
(281) 875-2020
Mailing address
1950 OLD GALLOWS RD STE 520, VIENNA, VA 22182-3970
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2554T
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11616014
CAQH
—
05
—
1548190-04
—
TX
05
—
1548190-06
—
TX
Enumeration date
02/22/2006
Last updated
11/23/2021
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