Provider Demographics
NPI:1689455057
Name:HERR, MIKALA WINDSOR (OD)
Entity Type:Individual
Prefix:
First Name:MIKALA
Middle Name:WINDSOR
Last Name:HERR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 DUNFORD WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-6021
Mailing Address - Country:US
Mailing Address - Phone:916-600-6135
Mailing Address - Fax:
Practice Address - Street 1:3451 S DOGWOOD RD STE 1334
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-9140
Practice Address - Country:US
Practice Address - Phone:760-336-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35604152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist