1912285610 NPI number — IRIS MAUREEN MILLER O.D.

Table of content: IRIS MAUREEN MILLER O.D. (NPI 1912285610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912285610 NPI number — IRIS MAUREEN MILLER O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
IRIS
Provider Middle Name:
MAUREEN
Provider Name Prefix Text:
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:
RAFFERTY
Provider Other First Name:
IRIS
Provider Other Middle Name:
MAUREEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912285610
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 BALD HILL RD
Provider Second Line Business Mailing Address:
SUITE 504, WARWICK MED BLDG
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02886
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-463-3500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 TOLL GATE RD
Provider Second Line Business Practice Location Address:
SUITE 101B
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02886-4416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-463-3500
Provider Business Practice Location Address Fax Number:
401-739-9670
Provider Enumeration Date:
07/28/2011

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:  ODTG00560 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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