1194026468 NPI number — C. ANNE MILLER O.D., P.C.

Table of content: (NPI 1194026468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194026468 NPI number — C. ANNE MILLER O.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
C. ANNE MILLER O.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MY EYE SITE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194026468
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 SHORTHORN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR PARK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78613-7770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-507-4674
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13201 N FM 620
Provider Second Line Business Practice Location Address:
SUITE 127
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78717-1011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-335-2077
Provider Business Practice Location Address Fax Number:
512-335-2811
Provider Enumeration Date:
11/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
C.
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
512-335-2077

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  5943TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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