Provider Demographics
NPI:1861044182
Name:MILES, ANNA R (OD)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:R
Last Name:MILES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14994 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39339-2616
Mailing Address - Country:US
Mailing Address - Phone:627-733-4946
Mailing Address - Fax:662-773-7883
Practice Address - Street 1:14994 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39339-2616
Practice Address - Country:US
Practice Address - Phone:662-773-3494
Practice Address - Fax:662-773-7883
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS996152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist