MEDICARE: MRS. JUDITH LYNN MILES O.D.

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	T03131	MO

General Provider Information

NPI Number	:	1588662746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUDITH LYNN MILES O.D.

Provider Business Mailing Address
First Line	:	200 S KIRKWOOD RD STE 130
Second Line	:
City	:	KIRKWOOD
State	:	MO
Zip	:	63122-4335
Country	:	US
Telephone Number	:	314-394-3045
Fax Number	:	314-394-3049

Provider Business Practice Location Address
First Line	:	200 S KIRKWOOD RD STE 130
Second Line	:
City	:	KIRKWOOD
State	:	MO
Zip	:	63122-4335
Country	:	US
Telephone Number	:	314-394-3045
Fax Number	:	314-394-3049

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	11/13/2024

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