Jonathan Edward Micetich, O.D. Valid NPI

Individual provider · Optometrist · Coal City, IL

NPI

1740273754

Type

Individual (Type 1)

Primary specialty

Optometrist

Specialty group

Eye and Vision Services Providers

Taxonomy code

152W00000X

License number

046008925 (IL)

Sex

Male

Sole proprietor

Yes

Enumerated

2005-08-24

Last updated

2021-03-25