Healthcare Provider Details

I. General information

NPI: 1194979047
Provider Name (Legal Business Name): MILLER OPTICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43560 VAN DYKE AVE
STERLING HEIGHTS MI
48314-2436
US

IV. Provider business mailing address

43560 VAN DYKE AVE
STERLING HEIGHTS MI
48314-2436
US

V. Phone/Fax

Practice location:
  • Phone: 586-254-9600
  • Fax: 586-254-6787
Mailing address:
  • Phone: 586-254-9600
  • Fax: 586-254-6787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901002931
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY THOMAS MILLER
Title or Position: PRESIDENT
Credential:
Phone: 586-254-9600