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: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 4TH ST NE
STAPLES MN
56479-2428
US

IV. Provider business mailing address

5782 GORRON RD
BRAINERD MN
56401-2498
US

V. Phone/Fax

Practice location:
  • Phone: 218-894-1331
  • Fax: 218-894-1335
Mailing address:
  • Phone: 320-630-1214
  • 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: