Provider Demographics
NPI:1588643878
Name:MITTELMAN, MICHAEL H (OD, MPH)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:H
Last Name:MITTELMAN
Suffix:
Gender:M
Credentials:OD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8360 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1598
Mailing Address - Country:US
Mailing Address - Phone:215-780-1280
Mailing Address - Fax:
Practice Address - Street 1:8360 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1598
Practice Address - Country:US
Practice Address - Phone:215-780-1280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002881152W00000X
WI1752152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist