Provider Demographics
NPI:1710110598
Name:DR. JOE E.MILLER II OPTOMETRIST PA
Entity Type:Organization
Organization Name:DR. JOE E.MILLER II OPTOMETRIST PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:386-846-8278
Mailing Address - Street 1:173 INTEGRA BREEZE LN
Mailing Address - Street 2:UNIT#103
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5589
Mailing Address - Country:US
Mailing Address - Phone:386-846-8278
Mailing Address - Fax:
Practice Address - Street 1:173 INTEGRA BREEZE LN
Practice Address - Street 2:UNIT#103
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5589
Practice Address - Country:US
Practice Address - Phone:386-846-8278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2082152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL935164OtherEYEMED
FL85281Medicare UPIN