Provider Demographics
NPI:1720583297
Name:AMIN, MIRA
Entity Type:Individual
Prefix:
First Name:MIRA
Middle Name:
Last Name:AMIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 WELSH RD STE 220
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-2056
Mailing Address - Country:US
Mailing Address - Phone:152-542-1522
Mailing Address - Fax:
Practice Address - Street 1:1140 WELSH RD STE 220
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-2056
Practice Address - Country:US
Practice Address - Phone:215-542-1522
Practice Address - Fax:215-542-9609
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC87602207W00000X
PA480897207WX0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology