Healthcare Provider Details

I. General information

NPI: 1003606237
Provider Name (Legal Business Name): EVAN MILLER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2025
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W CAMELBACK RD STE 1
PHOENIX AZ
85013-2563
US

IV. Provider business mailing address

114 W CAMELBACK RD STE 1
PHOENIX AZ
85013-2563
US

V. Phone/Fax

Practice location:
  • Phone: 602-264-4104
  • Fax:
Mailing address:
  • Phone: 602-264-4104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-002885
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: