Provider Demographics
NPI:1992757819
Name:MIA L MILLER & MARGARET M
Entity type:Organization
Organization Name:MIA L MILLER & MARGARET M
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:M
Authorized Official - Last Name:STOLARCZUK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-526-2242
Mailing Address - Street 1:180 EL CERRITO PLAZA
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530
Mailing Address - Country:US
Mailing Address - Phone:510-526-2242
Mailing Address - Fax:510-526-2748
Practice Address - Street 1:180 EL CERRITO PLAZA
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530
Practice Address - Country:US
Practice Address - Phone:510-526-2242
Practice Address - Fax:510-526-2748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT7996T152W00000X
CAOPT8866T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGS0001090Medicaid
CA0214350001Medicare NSC
CAGS0001090Medicaid
CA1962606996Medicare NSC