Provider Demographics
NPI:1689990517
Name:MILDENSTEIN, JOAN (OD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:
Last Name:MILDENSTEIN
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 1:3940 WALLINGFORD AVE N
Mailing Address - Street 2:APT. 305
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8263
Mailing Address - Country:US
Mailing Address - Phone:215-667-9168
Mailing Address - Fax:
Practice Address - Street 1:10024 SE 240TH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-5124
Practice Address - Country:US
Practice Address - Phone:253-852-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60119621152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist