Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XL0004X | Low Vision | 1789 | AZ |
NPI | 1770995342 |
---|---|
Provider Name | Ms. Marci S Miller |
First Address | Phoenix, AZ 85032-2382 |
Second Address | Mesa, AZ 85210-3056 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2014 |
Last Update Date | 29/05/2014 |