Provider Demographics
NPI:1124345756
Name:STOLPE, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:STOLPE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:STOLPE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:18455 BURBANK BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-6627
Mailing Address - Country:US
Mailing Address - Phone:818-758-1666
Mailing Address - Fax:818-758-1786
Practice Address - Street 1:18455 BURBANK BLVD
Practice Address - Street 2:STE 202
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6627
Practice Address - Country:US
Practice Address - Phone:818-758-1666
Practice Address - Fax:818-758-1786
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA09-336-15156FX1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6419480001Medicare NSC