# DR. MORIO MIYAMOTO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1588722748
- **Gender:** Man
- **Credential:** O.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152WC0802X | Corneal and Contact Management Optometrist | T2320 | MO | Yes |

## Other

- **Enumeration date:** 12/04/2006
- **Last updated:** 09/18/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000007673 | MEDICARE PTAN | MO |
| 01 | — | 0791940001 | MEDICARE REGIOND/DMERC | MO |
| 05 | — | 310753819 | — | MO |