Provider Demographics
NPI:1902977267
Name:MILLER, ANTHONY GW (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:GW
Last Name:MILLER
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1543 MAKIKI ST
Mailing Address - Street 2:403
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-4505
Mailing Address - Country:US
Mailing Address - Phone:808-949-7288
Mailing Address - Fax:
Practice Address - Street 1:508 ATKINSON DR
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4728
Practice Address - Country:US
Practice Address - Phone:808-949-7288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDIO-96156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIDIO-96OtherDISPENSING OPTICIAN