Provider Demographics
NPI:1073614038
Name:MILLER, MICHELLE MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 S MAINE ST
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-3342
Mailing Address - Country:US
Mailing Address - Phone:775-423-7411
Mailing Address - Fax:775-423-4785
Practice Address - Street 1:448 S MAINE ST
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-3342
Practice Address - Country:US
Practice Address - Phone:775-423-7411
Practice Address - Fax:775-423-4785
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV290152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002516050Medicaid
NVVOD290AMedicare PIN
NVU37446Medicare UPIN
NV002516050Medicaid