Provider Demographics
NPI:1447587662
Name:EDWARD C MILLER OD PA
Entity Type:Organization
Organization Name:EDWARD C MILLER OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-921-7470
Mailing Address - Street 1:260 CRANDON BLVD
Mailing Address - Street 2:32-224
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149-1536
Mailing Address - Country:US
Mailing Address - Phone:954-921-7470
Mailing Address - Fax:
Practice Address - Street 1:1780 STIRLING RD. #101
Practice Address - Street 2:
Practice Address - City:DANIA
Practice Address - State:FL
Practice Address - Zip Code:33004
Practice Address - Country:US
Practice Address - Phone:954-920-9243
Practice Address - Fax:954-920-5718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1768152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty