Individual
DR. ERIC E MIEDEMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1700 MCHENRY AVENUE, SUITE 77, MODESTO, CA 95350-4318
(209) 524-4626
(209) 524-1046
Mailing address
1700 MCHENRY AVENUE, SUITE 77, MODESTO, CA 95350-4318
(209) 524-4626
(209) 524-1046
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT9947TPA
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
410020358
RAILROAD MEDICARE
—
01
—
94217822195350B2
TRICARE
—
05
—
SD0099470
—
CA
Enumeration date
11/17/2006
Last updated
12/27/2007
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