Provider Demographics
NPI:1295039683
Name:CRAIG D MILLER LLC
Entity Type:Organization
Organization Name:CRAIG D MILLER LLC
Other - Org Name:GAHANNA VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-471-7177
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5497152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9392401Medicare PIN