Provider Demographics
NPI:1164823357
Name:MIKOLICH, ASHLIN ANN (DR)
Entity Type:Individual
Prefix:
First Name:ASHLIN
Middle Name:ANN
Last Name:MIKOLICH
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:1525 W WT HARRIS BLVD
Practice Address - Street 2:MAIL CODE 5998 BLDG 1A1
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28288-0001
Practice Address - Country:US
Practice Address - Phone:704-295-4433
Practice Address - Fax:704-295-4442
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2387152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist