Provider Demographics
NPI:1053310243
Name:MILLER, MELANIE KAY (OD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:KAY
Last Name:MILLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MELANIE
Other - Middle Name:KAY
Other - Last Name:OLTMANNS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2273 3RD AVE W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-2605
Mailing Address - Country:US
Mailing Address - Phone:701-225-7886
Mailing Address - Fax:701-225-8148
Practice Address - Street 1:2273 3RD AVE W
Practice Address - Street 2:STE D-1
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-2605
Practice Address - Country:US
Practice Address - Phone:701-225-7886
Practice Address - Fax:701-225-8148
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND560152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND60511Medicaid
ND25219Medicare ID - Type Unspecified
U66512Medicare UPIN