Provider Demographics
NPI:1962672675
Name:DR. GARY S. MILLER & ASSOCIATES, OPTOMETRISTS, PA
Entity Type:Organization
Organization Name:DR. GARY S. MILLER & ASSOCIATES, OPTOMETRISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-509-4490
Mailing Address - Street 1:6801 NORTHLAKE MALL DR
Mailing Address - Street 2:NORTHLAKE MALL #253
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-0711
Mailing Address - Country:US
Mailing Address - Phone:704-509-4490
Mailing Address - Fax:704-509-4491
Practice Address - Street 1:6801 NORTHLAKE MALL DR
Practice Address - Street 2:NORTHLAKE MALL #253
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-0711
Practice Address - Country:US
Practice Address - Phone:704-509-4490
Practice Address - Fax:704-509-4491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1307152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2472571Medicare PIN