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General NPI Number Information
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NPI Number | 1710110598
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Entity Type | Organization
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Legal Business Name | DR. JOE E.MILLER II OPTOMETRIST PA
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Dates
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Enumeration Date | 08/27/2009
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Last Update Date | 06/22/2012
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Provider Practice Location Address
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Address Line | 173 INTEGRA BREEZE LN UNIT#103
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5589
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Country | US
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Telephone | 386-846-8278
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Fax |
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Provider Business Mailing Address
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Address Line | 173 INTEGRA BREEZE LN UNIT#103
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5589
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Country | US
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Telephone | 386-846-8278
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOE E. MILLER II
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Credential | O.D.
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Telephone | 386-846-8278
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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 | OPC2082
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License Number State | FL
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