=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144283441
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARTIN PAUL MILLER O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2006
-----------------------------------------------------
Last Update Date | 12/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1230 W 16TH ST
-----------------------------------------------------
City | MERCED
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95340-4536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-722-2743
-----------------------------------------------------
Fax | 209-722-0057
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1230 W 16TH ST
-----------------------------------------------------
City | MERCED
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95340-4536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-722-2743
-----------------------------------------------------
Fax | 209-722-0057
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 6086T
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------