Healthcare Provider Details

I. General information

NPI: 1902977267
Provider Name (Legal Business Name): ANTHONY GW MILLER OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 ATKINSON DR
HONOLULU HI
96814-4728
US

IV. Provider business mailing address

1543 MAKIKI ST 403
HONOLULU HI
96822-4505
US

V. Phone/Fax

Practice location:
  • Phone: 808-949-7288
  • Fax:
Mailing address:
  • Phone: 808-949-7288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberDIO-96
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: