Provider Demographics
NPI:1306896303
Name:MIRANDA, CARRIE JOY (O D)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:JOY
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 MONTANA DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-4626
Mailing Address - Country:US
Mailing Address - Phone:928-778-2274
Mailing Address - Fax:928-778-2274
Practice Address - Street 1:1680 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1108
Practice Address - Country:US
Practice Address - Phone:928-778-3950
Practice Address - Fax:928-778-3999
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0844152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist