Healthcare Provider Details

I. General information

NPI: 1780707919
Provider Name (Legal Business Name): JAMES C MILLER III OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32925 GROESBECK HIGHWAY
FRASER MI
48026
US

IV. Provider business mailing address

32925 GROESBECK HIGHWAY
FRASER MI
48026
US

V. Phone/Fax

Practice location:
  • Phone: 586-293-8888
  • Fax: 586-296-0726
Mailing address:
  • Phone: 586-293-8888
  • Fax: 586-296-0726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003024
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: