Organization
MILLER CORRECTIONAL CARE OPTOMETRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KRYSTLE MILLER OD (OPTOMETRIST OWNER)
(708) 552-7429
Entity
Organization
Contact information
Practice address
4979 INDIANA AVE, LISLE, IL 60532
(312) 279-8644
Mailing address
4979 INDIANA AVE, LISLE, IL 60532
(312) 279-8644
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578998936
—
IL
Enumeration date
02/12/2020
Last updated
02/13/2020
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