Provider Demographics
NPI:1235325473
Name:GORDON A MILLER MD PC
Entity Type:Organization
Organization Name:GORDON A MILLER MD PC
Other - Org Name:WILLAMETTE VALLEY EYECENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-363-1500
Mailing Address - Street 1:2001 COMMERCIAL ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5207
Mailing Address - Country:US
Mailing Address - Phone:503-363-1500
Mailing Address - Fax:503-588-2028
Practice Address - Street 1:2001 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-5207
Practice Address - Country:US
Practice Address - Phone:503-363-1500
Practice Address - Fax:503-588-2028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD11962261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR756183994OtherRAILROAD MEDICARE
OR006291Medicaid
ORR0000WCQHYMedicare PIN
OR756183994OtherRAILROAD MEDICARE