Provider Demographics
NPI:1568156602
Name:MILLER, BRANDT RILEY (OD)
Entity Type:Individual
Prefix:
First Name:BRANDT
Middle Name:RILEY
Last Name:MILLER
Suffix:
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 1:6995 STATE ROUTE 241
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44654-9469
Mailing Address - Country:US
Mailing Address - Phone:330-231-0505
Mailing Address - Fax:
Practice Address - Street 1:110 ANDREAS DR NE
Practice Address - Street 2:
Practice Address - City:SUGARCREEK
Practice Address - State:OH
Practice Address - Zip Code:44681-7503
Practice Address - Country:US
Practice Address - Phone:330-852-2512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH007158152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist