Active NPI
Miles Eye Center, PLLC
- Ophthalmology Physician
- Lakeside, AZ
National Provider Identifier
1184032963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- Legal business name
- MILES EYE CENTER, PLLC
- Practice address
- 1355 W White Mountain Blvd
Suite a
Lakeside, AZ 85929-6395 - Phone
- (928) 367-2010
- Fax
- (928) 535-5561
- NPI assigned
- Jul 24, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Linda S Burgess
- Title
- Credentialing Manager
- Phone
- (928) 535-6667
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | |||
| Ophthalmology Physician | 207W00000X | Primary |
Addresses
Primary practice location
1355 W White Mountain Blvd
Suite a
Lakeside, AZ 85929-6395
Mailing address
PO Box 969
Overgaard, AZ 85933-0969
Phone (928) 535-6667
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 586099 | Medicaid | AZ |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1406160000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1406160000000",
"number": "1184032963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 969",
"city": "OVERGAARD",
"state": "AZ",
"postal_code": "859330969",
"telephone_number": "928-535-6667",
"fax_number": "928-535-5561"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1355 W WHITE MOUNTAIN BLVD",
"address_2": "SUITE A",
"city": "LAKESIDE",
"state": "AZ",
"postal_code": "859296395",
"telephone_number": "928-367-2010",
"fax_number": "928-535-5561"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MILES EYE CENTER, PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2014-07-24",
"last_updated": "2014-07-24",
"status": "A",
"authorized_official_last_name": "BURGESS",
"authorized_official_first_name": "LINDA",
"authorized_official_middle_name": "S",
"authorized_official_title_or_position": "CREDENTIALING MANAGER",
"authorized_official_telephone_number": "928-535-6667"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Optometrist",
"state": null,
"license": null,
"primary": false
},
{
"code": "207W00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Ophthalmology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "586099",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Lakeside, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.