Individual
DR. GREGORY LEE MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
138 N GRANT AVE, MANTECA, CA 95336-4601
(209) 823-7146
(209) 823-0670
Mailing address
138 N GRANT AVE, MANTECA, CA 95336-4601
(209) 823-7146
(209) 823-0670
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
05909T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3417
MESC
CA
01
—
45547
SAFEGUARD
CA
01
—
SD0059090
MEDICARE PTAN
CA
05
—
SD0059090
—
CA
Enumeration date
02/02/2006
Last updated
11/12/2013
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