Provider Demographics
NPI:1073682076
Name:MILLER, ROBERT L (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
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 1:500 S PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HARTVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44632-9403
Mailing Address - Country:US
Mailing Address - Phone:330-877-2117
Mailing Address - Fax:330-877-1617
Practice Address - Street 1:500 S PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HARTVILLE
Practice Address - State:OH
Practice Address - Zip Code:44632-9403
Practice Address - Country:US
Practice Address - Phone:330-877-2117
Practice Address - Fax:330-877-1617
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4371152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU33316Medicare UPIN