MEDICARE: DOUGLAS CHARLES MINER 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	OPT-000641	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	116725	OTHER		MEDICARE PTAN

General Provider Information

NPI Number	:	1942255906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS CHARLES MINER O.D.

Provider Business Mailing Address
First Line	:	8614 WESTWOOD CENTER DR FL 9
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-2442
Country	:	US
Telephone Number	:	703-847-8899
Fax Number	:	571-223-6780

Provider Business Practice Location Address
First Line	:	1635 N GREENFIELD RD
Second Line	:	SUITE 136
City	:	MESA
State	:	AZ
Zip	:	85205-4005
Country	:	US
Telephone Number	:	480-219-2412
Fax Number	:	480-219-2843

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	04/08/2026

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Directions to “ DOUGLAS CHARLES MINER O.D.” Practice Location

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