1568587327 NPI number — RICHARD A MILLER OD PC

Table of content: (NPI 1568587327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568587327 NPI number — RICHARD A MILLER OD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD A MILLER OD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MILLER VISION
Provider Other Organization Name Type Code:
3
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:
1568587327
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
240 ROOSEVELT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRONWOOD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49938-1737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-932-3005
Provider Business Mailing Address Fax Number:
906-932-3188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 ROOSEVELT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRONWOOD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49938-1737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-932-3005
Provider Business Practice Location Address Fax Number:
906-932-3188
Provider Enumeration Date:
03/20/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
906-932-3005

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  5330000179 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4104809 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 900B710380 . This is a "BCNETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 900B710380 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 900B765010 . This is a "MI BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 38563800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".