Provider Demographics
NPI:1639308778
Name:COLLINS, MIRANDA A (OD)
Entity Type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:A
Last Name:COLLINS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MIRANDA
Other - Middle Name:S
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874-0129
Mailing Address - Country:US
Mailing Address - Phone:423-920-2262
Mailing Address - Fax:423-558-3213
Practice Address - Street 1:935 HIGHWAY 11 S
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TN
Practice Address - Zip Code:37874-5730
Practice Address - Country:US
Practice Address - Phone:423-920-2262
Practice Address - Fax:423-558-3213
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3657152W00000X, 152W00000X
VA0618001932152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist