Provider Demographics
NPI:1306456850
Name:MILLER, MAIYA COOPER (OD)
Entity type:Individual
Prefix:DR
First Name:MAIYA
Middle Name:COOPER
Last Name:MILLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MAIYA
Other - Middle Name:RENEE
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:6705 S GARTH AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-2205
Mailing Address - Country:US
Mailing Address - Phone:310-508-0295
Mailing Address - Fax:
Practice Address - Street 1:3631 CRENSHAW BLVD STE 109
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-4869
Practice Address - Country:US
Practice Address - Phone:323-732-0100
Practice Address - Fax:323-732-0104
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34645152W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program