Provider Demographics
NPI:1134127871
Name:MILLER, RICHARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2995 EASTROCK DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61109-1737
Mailing Address - Country:US
Mailing Address - Phone:815-226-1500
Mailing Address - Fax:815-484-9600
Practice Address - Street 1:2995 EASTROCK DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61109-1737
Practice Address - Country:US
Practice Address - Phone:815-226-1500
Practice Address - Fax:815-484-9600
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03606603207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03606603Medicaid
ILD93417Medicare UPIN
IL743192Medicare PIN