Provider Demographics
NPI:1407841919
Name:HERMAN, MILTON PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:PAUL
Last Name:HERMAN
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 1:117 GLOVER ST.
Mailing Address - Street 2:
Mailing Address - City:TWISP
Mailing Address - State:WA
Mailing Address - Zip Code:98856-0578
Mailing Address - Country:US
Mailing Address - Phone:509-997-5201
Mailing Address - Fax:509-997-5202
Practice Address - Street 1:117 GLOVER ST.
Practice Address - Street 2:
Practice Address - City:TWISP
Practice Address - State:WA
Practice Address - Zip Code:98856
Practice Address - Country:US
Practice Address - Phone:509-997-5201
Practice Address - Fax:509-997-5202
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1043 TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0086930OtherLABOR AND INDUSTRY
WA2939304Medicaid
WA000300656Medicare PIN
WA0086930OtherLABOR AND INDUSTRY
WA0300160002Medicare NSC