1477616423 NPI number — DR. STANLEY DAVID MILLER O.D., M.S., FAAO

Table of content: DR. STANLEY DAVID MILLER O.D., M.S., FAAO (NPI 1477616423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477616423 NPI number — DR. STANLEY DAVID MILLER O.D., M.S., FAAO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
STANLEY
Provider Middle Name:
DAVID
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D., M.S., FAAO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477616423
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 BEMIS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02493-1701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-899-7751
Provider Business Mailing Address Fax Number:
--

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
56 COLPITTS RD
Provider Second Line Business Practice Location Address:
EYE & OPTICAL
Provider Business Practice Location Address City Name:
WESTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02493-1568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-899-7751
Provider Business Practice Location Address Fax Number:
--
Provider Enumeration Date:
12/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2263 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 757526 . This is a "TUFTS HEALTH PLAN ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: W15986 . This is a "BCBS OF MASS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0891138 OR B2119401 . This is a "CIGNA HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2569545 . This is a "US HEALTH AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 152625 . This is a "HARVARD PILGRIM HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".