Provider Demographics
NPI:1306833645
Name:MILLER, SCOTT ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALAN
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:PO BOX 275
Mailing Address - Street 2:
Mailing Address - City:DELPHI
Mailing Address - State:IN
Mailing Address - Zip Code:46923-0275
Mailing Address - Country:US
Mailing Address - Phone:765-564-2800
Mailing Address - Fax:765-564-2477
Practice Address - Street 1:750 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DELPHI
Practice Address - State:IN
Practice Address - Zip Code:46923-1327
Practice Address - Country:US
Practice Address - Phone:765-564-2800
Practice Address - Fax:765-564-2477
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-800-3231-B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200899700Medicaid
IN000000564779OtherANTHEM
IN000000574587OtherANTHEM
INU96712Medicare UPIN
IN200899700Medicaid