Individual provider Active NPI

Carrie Joy Miranda, O. D.

  • Optometrist
  • Prescott, AZ
National Provider Identifier
1306896303
Registry record updated Nov 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
0844 Issued in AZ
Practice address
1680 Willow Creek Rd
Prescott, AZ 86301-1108
Phone
(928) 778-3950
Fax
(928) 778-3999
NPI assigned
May 11, 2006
Last updated
Nov 14, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 0844 AZ Primary

Addresses

Primary practice location

1680 Willow Creek Rd
Prescott, AZ 86301-1108

Mailing address

3120 Montana Dr
Prescott, AZ 86301-4626
Phone (928) 778-2274

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110210000356 AZ Practitioner - Optometry 4880679349 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3400 Gateway Blvd
Prescott, AZ 86303-6848
Phone (928) 778-4402

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0844AZMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Miranda Optometry, P. C. Optometrist CurrentSince Jul 2, 2001 Accepting new patients

Locations

1680 Willow Creek Rd
Prescott, AZ 86301
Phone (928) 320-2306

3400 Gateway Blvd
Prescott, AZ 86303
Phone (928) 778-4402

720 N Montezuma St
Ste C
Prescott, AZ 86301
Phone (928) 308-0519

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415923200000",
    "number": "1306896303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3120 MONTANA DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863014626",
            "telephone_number": "928-778-2274",
            "fax_number": "928-778-2274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1680 WILLOW CREEK RD",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011108",
            "telephone_number": "928-778-3950",
            "fax_number": "928-778-3999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRANDA",
        "first_name": "CARRIE",
        "middle_name": "JOY",
        "credential": "O. D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-11",
        "last_updated": "2014-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "0844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott, AZ

Sources for this page

Verify at the official NPI Registry.