Provider Demographics
NPI:1497818314
Name:MILLER OPTOMETRY, INC.
Entity Type:Organization
Organization Name:MILLER OPTOMETRY, INC.
Other - Org Name:VISIONHEALTH EYECARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WAY
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:414-769-6120
Mailing Address - Street 1:5102 S PACKARD AVE
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-1922
Mailing Address - Country:US
Mailing Address - Phone:414-769-6120
Mailing Address - Fax:414-769-6998
Practice Address - Street 1:5102 S PACKARD AVE
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-1922
Practice Address - Country:US
Practice Address - Phone:414-769-6120
Practice Address - Fax:414-769-6998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI2195152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38532100Medicaid
WI38532100Medicaid
WIT62780Medicare UPIN