Provider Demographics
NPI:1922299320
Name:MIRANDA OPTOMETRY, P. C.
Entity Type:Organization
Organization Name:MIRANDA OPTOMETRY, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:928-443-1743
Mailing Address - Street 1:3120 MONTANA DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-4626
Mailing Address - Country:US
Mailing Address - Phone:928-443-1743
Mailing Address - Fax:928-442-3120
Practice Address - Street 1:720 N MONTEZUMA ST STE C
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2068
Practice Address - Country:US
Practice Address - Phone:928-443-1743
Practice Address - Fax:928-442-3120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ844152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty