1912285610 NPI number — IRIS MAUREEN MILLER O.D.

Table of content: MR. GARY A GALANTE OD (NPI 1003893587)

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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