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General NPI Number Information
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NPI Number | 1427160753
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Entity Type | Individual
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Provider Name | CHARLES ALAN MIRANDA O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 06/29/2016
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Provider Practice Location Address
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Address Line | 927 ETHAN ALLEN HIGHWAY SUITE 4
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City | GEORGIA
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State | VT
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Zip | 05468-9746
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Country | US
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Telephone | 802-527-1126
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Fax | 802-524-7010
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Provider Business Mailing Address
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Address Line | PO BOX 2066
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City | MILTON
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State | VT
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Zip | 05468-2066
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Country | US
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Telephone | 802-527-1126
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Fax | 802-524-7010
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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 | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | VT 187
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License Number State | VT
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