Healthcare Provider Details

I. General information

NPI: 1164514568
Provider Name (Legal Business Name): DOUGLAS G MILLER MD & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 W MADISON AVENUE SUITE 2
EL CAJON CA
92020-3454
US

IV. Provider business mailing address

225 W MADISON AVENUE SUITE 2
EL CAJON CA
92020-3454
US

V. Phone/Fax

Practice location:
  • Phone: 619-442-3937
  • Fax: 619-441-0539
Mailing address:
  • Phone: 619-442-3937
  • Fax: 619-441-0539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT00009730TPA
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG52627
License Number StateCA

VIII. Authorized Official

Name: DOUGLAS GENE MILLER
Title or Position: MD
Credential: MD
Phone: 619-442-3937