Provider Demographics
NPI:1033145511
Name:BRUCE A. MILLER MD PA
Entity Type:Organization
Organization Name:BRUCE A. MILLER MD PA
Other - Org Name:PEDIATRIC OPHTHALMOLOGY CONSULTANTS OF SO. FL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-424-5959
Mailing Address - Street 1:220 SW 84TH AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2754
Mailing Address - Country:US
Mailing Address - Phone:954-424-5959
Mailing Address - Fax:954-424-1415
Practice Address - Street 1:220 SW 84TH AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2754
Practice Address - Country:US
Practice Address - Phone:954-424-5959
Practice Address - Fax:954-424-1415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55541174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2750Medicare ID - Type Unspecified