Provider Demographics
NPI:1508825852
Name:MILLMAN, RONALD
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:MILLMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 N MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-3910
Mailing Address - Country:US
Mailing Address - Phone:973-366-1571
Mailing Address - Fax:973-366-1576
Practice Address - Street 1:16 N MORRIS ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-3910
Practice Address - Country:US
Practice Address - Phone:973-366-1571
Practice Address - Fax:973-366-1576
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00279900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1235303Medicaid
NJ1235303Medicaid
NJMI111078Medicare PIN
NJ4733390001Medicare NSC