Provider Demographics
NPI:1134133606
Name:MILLER, CRAIG DANIEL (OD)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:DANIEL
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 1:159 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-3028
Mailing Address - Country:US
Mailing Address - Phone:614-471-7177
Mailing Address - Fax:614-471-7225
Practice Address - Street 1:159 N HIGH ST
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3028
Practice Address - Country:US
Practice Address - Phone:614-471-7177
Practice Address - Fax:614-471-7225
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5497152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2531817Medicaid
OH2531817Medicaid