=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487877064
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MILLER AND MILLER, OD LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2007
-----------------------------------------------------
Last Update Date | 11/29/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7901 W TROPICAL PKWY SUITE 130
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89149-4549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-737-3937
-----------------------------------------------------
Fax | 702-737-8860
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7901 W TROPICAL PKWY SUITE 130
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89149-4549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-737-3937
-----------------------------------------------------
Fax | 702-737-8860
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARK DOUGLAS MILLER
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 702-737-3937
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------