Organization Active NPI

Miles Eye Center, PLLC

  • Ophthalmology Physician
  • Lakeside, AZ
National Provider Identifier
1184032963
Registry record updated Jul 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
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

Updated by the provider on Jul 24, 2014

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)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 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

IdentifierTypeStateIssuer
586099MedicaidAZ

National Provider Directory

National Provider Directory

Practitioners & 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.

Verify at the official NPI Registry.