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General NPI Number Information
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NPI Number | 1922299320
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Entity Type | Organization
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Legal Business Name | MIRANDA OPTOMETRY, P. C.
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 08/09/2007
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Provider Practice Location Address
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Address Line | 720 N MONTEZUMA ST STE C
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City | PRESCOTT
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State | AZ
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Zip | 86301-2068
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Country | US
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Telephone | 928-443-1743
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Fax | 928-442-3120
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Provider Business Mailing Address
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Address Line | 3120 MONTANA DR
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City | PRESCOTT
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State | AZ
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Zip | 86301-4626
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Country | US
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Telephone | 928-443-1743
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Fax | 928-442-3120
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARRIE JOY MIRANDA
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Credential | O. D.
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Telephone | 928-443-1743
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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 | 844
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License Number State | AZ
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