Healthcare Provider Details

I. General information

NPI: 1083603831
Provider Name (Legal Business Name): DANISE JOANN MILLER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15088 22ND AVE NE
LITTLE FALLS MN
56345-4199
US

IV. Provider business mailing address

15088 22ND AVE NE
LITTLE FALLS MN
56345-4199
US

V. Phone/Fax

Practice location:
  • Phone: 320-632-1950
  • Fax: 320-632-2558
Mailing address:
  • Phone: 320-632-1950
  • Fax: 320-632-2558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberMN2873
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: