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General NPI Number Information
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NPI Number | 1962672675
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Entity Type | Organization
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Legal Business Name | DR. GARY S. MILLER & ASSOCIATES, OPTOMETRISTS, PA
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 10/17/2008
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Provider Practice Location Address
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Address Line | 6801 NORTHLAKE MALL DR NORTHLAKE MALL #253
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City | CHARLOTTE
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State | NC
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Zip | 28216-0711
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Country | US
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Telephone | 704-509-4490
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Fax | 704-509-4491
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Provider Business Mailing Address
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Address Line | 6801 NORTHLAKE MALL DR NORTHLAKE MALL #253
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City | CHARLOTTE
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State | NC
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Zip | 28216-0711
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Country | US
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Telephone | 704-509-4490
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Fax | 704-509-4491
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY STEPHEN MILLER
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Credential | O.D.
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Telephone | 704-509-4490
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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 | 1307
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License Number State | NC
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