Provider Demographics
NPI:1497855068
Name:MILLER, RICHARD E JR (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:MILLER
Suffix:JR
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 1:931 ASHTON OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-5658
Mailing Address - Country:US
Mailing Address - Phone:863-513-3374
Mailing Address - Fax:
Practice Address - Street 1:1371 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-7964
Practice Address - Country:US
Practice Address - Phone:863-688-4001
Practice Address - Fax:863-413-0227
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 0002686152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL911470OtherEYE MED
FL20468Medicare ID - Type Unspecified
FLU47281Medicare UPIN