Organization
KENNETH V. MISELIS, M.D. INC.
Active
Other names
HERITAGE EYE ASSOCIATES
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH VICTOR MISELIS M.D. (PRESIDENT)
(209) 465-5933
Entity
Organization
Contact information
Practice address
445 W POPLAR ST, STOCKTON, CA 95203-2426
(209) 465-5933
(209) 465-2562
Mailing address
445 W POPLAR ST, STOCKTON, CA 95203-2426
(209) 465-5933
(209) 465-2562
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G502810
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180033368
RAILROAD MEDICARE
CA
05
—
GR0050600
—
CA
Enumeration date
08/10/2006
Last updated
06/17/2020
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