Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 11760204-9934 | UT |
NPI | 1013532894 |
---|---|
Provider Name | Dr. Meagan Miles |
First Address | Salt Lake City, UT 84116-3546 |
Second Address | Salt Lake City, UT 84116-3546 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2020 |
Last Update Date | 08/06/2020 |