Provider Demographics
NPI:1801106778
Name:MILES EYE CARE, PC
Entity type:Organization
Organization Name:MILES EYE CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-476-2000
Mailing Address - Street 1:415 METRO AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-2805
Mailing Address - Country:US
Mailing Address - Phone:812-476-2000
Mailing Address - Fax:812-477-1533
Practice Address - Street 1:415 METRO AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2805
Practice Address - Country:US
Practice Address - Phone:812-476-2000
Practice Address - Fax:812-477-1533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002272A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400031448OtherMEDICARE INDIVIDUAL PTAN
INM100031447Medicare PIN
INM400031448OtherMEDICARE INDIVIDUAL PTAN
INDR0513Medicare PIN