Individual
DR. JOHN JOSEPH JICHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1391
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015MC
BCBS GROUP
—
01
—
09458
BCBS
—
01
—
1391
NC LICENSE
—
05
—
89015MC
—
NC
05
—
8909438
—
NC
Enumeration date
11/30/2005
Last updated
11/14/2017
Update your record
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