Healthcare Provider Details

I. General information

NPI: 1164458394
Provider Name (Legal Business Name): JOE D MILES O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 N UNION BLVD
COLORADO SPRINGS CO
80907-8703
US

IV. Provider business mailing address

3155 N UNION BLVD
COLORADO SPRINGS CO
80907-8703
US

V. Phone/Fax

Practice location:
  • Phone: 719-219-1312
  • Fax: 719-635-3578
Mailing address:
  • Phone: 719-219-1312
  • Fax: 719-635-3578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPT 1939
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: