Provider Demographics
NPI:1003819442
Name:MILLER, DENNIS R (OD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:R
Last Name:MILLER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 DUBOIS DR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3212
Mailing Address - Country:US
Mailing Address - Phone:574-269-2777
Mailing Address - Fax:574-371-4697
Practice Address - Street 1:2251 DUBOIS DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3212
Practice Address - Country:US
Practice Address - Phone:574-269-2777
Practice Address - Fax:574-371-4697
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001871A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100324560BMedicaid
IN100342560Medicaid
INU09527Medicare UPIN
IN100342560Medicaid
IN452320AMedicare PIN