=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881789154
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FRANK ANTHONY MIELE O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36 CHERRY TREE FARM RD
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07748-2237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-530-8629
-----------------------------------------------------
Fax | 732-870-0825
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36 CHERRY TREE FARM RD
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07748-2237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-530-8629
-----------------------------------------------------
Fax | 732-870-0825
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OAO04854
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------