Basic Information
| Provider Information | |||||||||
| NPI: | 1164823357 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIKOLICH | ||||||||
| FirstName: | ASHLIN | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8614 WESTWOOD CENTER DR FL 9 | ||||||||
| Address2: | |||||||||
| City: | VIENNA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221822442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038478899 | ||||||||
| FaxNumber: | 5712236780 | ||||||||
| Practice Location | |||||||||
| Address1: | 1525 W WT HARRIS BLVD | ||||||||
| Address2: | MAIL CODE 5998 BLDG 1A1 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282880001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042954433 | ||||||||
| FaxNumber: | 7042954442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2014 | ||||||||
| LastUpdateDate: | 06/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2387 | NC | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.