MEDICARE: CARRIE JOY MIRANDA O. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0844	AZ

General Provider Information

NPI Number	:	1306896303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE JOY MIRANDA O. D.

Provider Business Mailing Address
First Line	:	3120 MONTANA DR
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86301-4626
Country	:	US
Telephone Number	:	928-778-2274
Fax Number	:	928-778-2274

Provider Business Practice Location Address
First Line	:	1680 WILLOW CREEK RD
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86301-1108
Country	:	US
Telephone Number	:	928-778-3950
Fax Number	:	928-778-3999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	11/14/2014

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