Provider Demographics
NPI:1467570655
Name:MIHELICH, JOHN N (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:N
Last Name:MIHELICH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 E HARMONY RD UNIT D16
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-8000
Mailing Address - Country:US
Mailing Address - Phone:970-266-1243
Mailing Address - Fax:970-282-1681
Practice Address - Street 1:238 E HARMONY RD UNIT D16
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-8000
Practice Address - Country:US
Practice Address - Phone:970-266-1243
Practice Address - Fax:970-282-1681
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2251152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO416817ZPMRMedicare UPIN