Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 8807 | CA |
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 18002264 | IN |
NPI | 1205938271 |
---|---|
Provider Name | Mark D Miller |
First Address | Westfield, IN 46074-4328 |
Second Address | Noblesville, IN 46060-3640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 25/10/2021 |