Healthcare Provider Details

I. General information

NPI: 1871226324
Provider Name (Legal Business Name): PATRICK JAMES MIRANDA OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 OLD CAMP RD
THE VILLAGES FL
32162-1762
US

IV. Provider business mailing address

43309 US HIGHWAY 19 N
TARPON SPRINGS FL
34689-6221
US

V. Phone/Fax

Practice location:
  • Phone: 352-350-8484
  • Fax:
Mailing address:
  • Phone: 727-938-2020
  • Fax: 727-938-5606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC6134
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: