MEDICARE: MILLER AND MILLER, OD LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1487877064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLER AND MILLER, OD LTD

Provider Business Mailing Address
First Line	:	7901 W TROPICAL PKWY
Second Line	:	SUITE 130
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4549
Country	:	US
Telephone Number	:	702-737-3937
Fax Number	:	702-737-8860

Provider Business Practice Location Address
First Line	:	7901 W TROPICAL PKWY
Second Line	:	SUITE 130
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4549
Country	:	US
Telephone Number	:	702-737-3937
Fax Number	:	702-737-8860

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK DOUGLAS MILLER
Credential	:	O.D.
Telephone Number	:	702-737-3937

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	11/29/2012

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