Healthcare Provider Details

I. General information

NPI: 1902090053
Provider Name (Legal Business Name): STEVEN A. MILLER, O.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34806 YUCAIPA BLVD
YUCAIPA CA
92399-4235
US

IV. Provider business mailing address

34806 YUCAIPA BLVD
YUCAIPA CA
92399-4235
US

V. Phone/Fax

Practice location:
  • Phone: 909-797-0134
  • Fax: 909-790-4274
Mailing address:
  • Phone: 909-797-0134
  • Fax: 909-790-4274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number7527T
License Number StateCA

VIII. Authorized Official

Name: MRS. DORIS J GROVE
Title or Position: OFFICE MANAGER
Credential:
Phone: 909-797-0134