Provider Demographics
NPI:1164483202
Name:MILES, JOHN DAVID (OPTOMETRIST)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:MILES
Suffix:
Gender:M
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 METRO AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-2805
Mailing Address - Country:US
Mailing Address - Phone:812-476-2000
Mailing Address - Fax:812-477-1533
Practice Address - Street 1:415 METRO AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2805
Practice Address - Country:US
Practice Address - Phone:812-476-2000
Practice Address - Fax:812-477-1533
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002272152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400031448OtherINDIVIDUAL PTAN
INM400031448OtherINDIVIDUAL PTAN