Provider Demographics
NPI:1275641961
Name:ROBERT L. MILLER, OD INC.
Entity Type:Organization
Organization Name:ROBERT L. MILLER, OD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-893-2215
Mailing Address - Street 1:4913 W. MAIN ST
Mailing Address - Street 2:PO BOX 224
Mailing Address - City:BERLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44610
Mailing Address - Country:US
Mailing Address - Phone:330-893-2215
Mailing Address - Fax:330-893-3618
Practice Address - Street 1:4913 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:OH
Practice Address - Zip Code:44610
Practice Address - Country:US
Practice Address - Phone:330-893-2215
Practice Address - Fax:330-893-3618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4371152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0111739Medicaid
OHRO0721382Medicare ID - Type Unspecified
OH0111739Medicaid