Basic Information
| Provider Information | |||||||||
| NPI: | 1124183181 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MILLER EYECRE OF SPRINFIELD, PLLC | ||||||||
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| OtherOrganizationName: | MY EYE DR. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8614 WESTWOOD CENTER DR FL 9 | ||||||||
| Address2: | |||||||||
| City: | VIENNA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221822442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038478899 | ||||||||
| FaxNumber: | 5712236780 | ||||||||
| Practice Location | |||||||||
| Address1: | 6406 SPRINGFIELD PLZ | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221503428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034514577 | ||||||||
| FaxNumber: | 7034518549 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 05/25/2022 | ||||||||
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| AuthorizedOfficialLastName: | VOORHEIS | ||||||||
| AuthorizedOfficialFirstName: | ALYSSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSISTANT DIRECTOR OF MANAGED CARE | ||||||||
| AuthorizedOfficialTelephone: | 7038478899 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 0618000176 | VA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 6024310001 | 01 | DMERC | OTHER |