Active NPI
Brian Mikulla, MD
- Ophthalmology Physician
- Lake Charles, LA
National Provider Identifier
1194959585
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- MD.203922
- Practice address
- 1980 Tybee St
Lake Charles, LA 70605-4173 - Phone
- (337) 477-0963
- Fax
- (337) 477-1912
- NPI assigned
- May 13, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | MD.203922 | LA | Primary |
Addresses
Primary practice location
1980 Tybee St
Lake Charles, LA 70605-4173
Mailing address
PO Box 4765
Lake Charles, LA 70606-4765
Phone (337) 477-0963
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1242172800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1373846400000",
"number": "1194959585",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4765",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706064765",
"telephone_number": "337-477-0963",
"fax_number": "337-477-1912"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1980 TYBEE ST",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706054173",
"telephone_number": "337-477-0963",
"fax_number": "337-477-1912"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIKULLA",
"first_name": "BRIAN",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-05-13",
"last_updated": "2013-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "LA",
"license": "MD.203922",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Charles, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.