Individual
DOUGLAS CHARLES MINER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1635 N GREENFIELD RD, SUITE 136, MESA, AZ 85205-4005
(480) 219-2412
(480) 219-2843
Mailing address
8614 WESTWOOD CENTER DR FL 9, VIENNA, VA 22182-2442
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
641
AZ
152W00000X
Optometrist
Primary
OPT-000641
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116725
MEDICARE PTAN
—
Enumeration date
05/24/2006
Last updated
04/08/2026
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