Provider Demographics
NPI:1497779748
Name:MILLER, KATE L (OD)
Entity Type:Individual
Prefix:DR
First Name:KATE
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:L
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1640 W KEETOOWAH ST
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-3497
Mailing Address - Country:US
Mailing Address - Phone:918-456-2250
Mailing Address - Fax:918-456-2251
Practice Address - Street 1:1640 W KEETOOWAH ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-3497
Practice Address - Country:US
Practice Address - Phone:918-456-2250
Practice Address - Fax:918-456-2251
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK 2111152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$Medicare PIN
OKU46861Medicare UPIN
OK6171700001Medicare NSC