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General NPI Number Information
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NPI Number | 1740813211
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Entity Type | Organization
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Legal Business Name | MILLER CORRECTIONAL CARE OPTOMETRY PC
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Dates
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Enumeration Date | 02/12/2020
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Last Update Date | 02/13/2020
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Provider Practice Location Address
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Address Line | 4979 INDIANA AVE
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City | LISLE
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State | IL
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Zip | 60532
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Country | US
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Telephone | 312-279-8644
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Fax |
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Provider Business Mailing Address
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Address Line | 4979 INDIANA AVE
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City | LISLE
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State | IL
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Zip | 60532
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Country | US
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Telephone | 312-279-8644
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST OWNER
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Name | DR. KRYSTLE MILLER
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Credential | OD
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Telephone | 708-552-7429
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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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