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General NPI Number Information
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NPI Number | 1396477402
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Entity Type | Individual
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Provider Name | KATHLEEN C MILLER OD
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Gender | Female
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Dates
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Enumeration Date | 06/28/2022
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Last Update Date | 06/28/2022
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Provider Practice Location Address
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Address Line | 2465 WRIGHTSBORO RD
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City | AUGUSTA
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State | GA
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Zip | 30904-6244
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Country | US
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Telephone | 706-738-1102
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Fax |
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Provider Business Mailing Address
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Address Line | 1253 GREGORY LANDING DR
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City | NORTH AUGUSTA
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State | SC
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Zip | 29860-8054
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Country | US
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Telephone | 214-799-4724
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPT003425
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License Number State | GA
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