Provider Demographics
NPI:1114913639
Name:MILLER, WAYNE T (OD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:T
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 1:292 STATE ROUTE 375
Mailing Address - Street 2:
Mailing Address - City:WEST HURLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12491-5632
Mailing Address - Country:US
Mailing Address - Phone:845-679-0393
Mailing Address - Fax:845-679-0390
Practice Address - Street 1:292 STATE ROUTE 375
Practice Address - Street 2:
Practice Address - City:WEST HURLEY
Practice Address - State:NY
Practice Address - Zip Code:12491-5632
Practice Address - Country:US
Practice Address - Phone:845-679-0393
Practice Address - Fax:845-679-0390
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2008-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004438-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10035673-6564OtherCDPHP-HMO
NY906624OtherMVP-HMO
NY906624OtherMVP-HMO
NYT49094Medicare UPIN