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General NPI Number Information
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NPI Number | 1184032963
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Entity Type | Organization
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Legal Business Name | MILES EYE CENTER, PLLC
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Dates
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Enumeration Date | 07/24/2014
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Last Update Date | 07/24/2014
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Provider Practice Location Address
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Address Line | 1355 W WHITE MOUNTAIN BLVD SUITE A
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City | LAKESIDE
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State | AZ
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Zip | 85929-6395
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Country | US
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Telephone | 928-367-2010
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Fax | 928-535-5561
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Provider Business Mailing Address
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Address Line | PO BOX 969
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City | OVERGAARD
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State | AZ
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Zip | 85933-0969
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Country | US
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Telephone | 928-535-6667
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Fax | 928-535-5561
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | LINDA S BURGESS
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Credential |
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Telephone | 928-535-6667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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