Provider Demographics
NPI:1265116008
Name:MILLIEN, CORALIS DARA (OD)
Entity type:Individual
Prefix:
First Name:CORALIS
Middle Name:DARA
Last Name:MILLIEN
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 1:2141 S ALTERNATE A1A STE 210
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-4063
Mailing Address - Country:US
Mailing Address - Phone:561-747-3937
Mailing Address - Fax:561-747-8822
Practice Address - Street 1:2141 S ALTERNATE A1A STE 210
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-4063
Practice Address - Country:US
Practice Address - Phone:561-747-3937
Practice Address - Fax:561-747-8822
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC6234152W00000X
LA2004-950AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist