Healthcare Provider Details

I. General information

NPI: 1154397719
Provider Name (Legal Business Name): PETER LAWRENCE MILLER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SANTA RITA RD SUITE B
PLEASANTON CA
94566-5666
US

IV. Provider business mailing address

1400 SANTA RITA RD SUITE B
PLEASANTON CA
94566-5666
US

V. Phone/Fax

Practice location:
  • Phone: 925-846-4364
  • Fax: 925-846-7825
Mailing address:
  • Phone: 925-846-4364
  • Fax: 925-846-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9882T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: