1932360856 NPI number — DR. KATHERINE JOYCE MILLER O.D.

Table of content: DR. KATHERINE JOYCE MILLER O.D. (NPI 1932360856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932360856 NPI number — DR. KATHERINE JOYCE MILLER O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
KATHERINE
Provider Middle Name:
JOYCE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHUELL
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
JOYCE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932360856
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 PINE BLUFF RD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21801-7160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-749-1191
Provider Business Mailing Address Fax Number:
410-749-6111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10231 OLD OCEAN CITY BLVD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
BERLIN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21811-3566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-641-1744
Provider Business Practice Location Address Fax Number:
410-641-3803
Provider Enumeration Date:
06/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  TA2099 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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