Provider Demographics
NPI:1578030177
Name:MILES, MONICA LEE (OD)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:LEE
Last Name:MILES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 DELTONA BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-4204
Mailing Address - Country:US
Mailing Address - Phone:904-797-5760
Mailing Address - Fax:904-797-5762
Practice Address - Street 1:25 DELTONA BLVD STE 1
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4204
Practice Address - Country:US
Practice Address - Phone:904-797-5760
Practice Address - Fax:904-797-5762
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5605152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist