Provider Demographics
NPI:1568446359
Name:NEUMILLER, JOEL (OD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:NEUMILLER
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 1:1801 LONGLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-2171
Mailing Address - Country:US
Mailing Address - Phone:701-355-4782
Mailing Address - Fax:
Practice Address - Street 1:2717 ROCK ISLAND PL
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-7724
Practice Address - Country:US
Practice Address - Phone:701-258-3402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND552152WC0802X, 152WL0500X, 152WP0200X, 152WV0400X, 152WX0102X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND60498Medicaid
NDMEI30952OtherBLUE CROSS BLUE SHIELD OF ND
NDP00717242OtherRAILROAD MEDICARE
NDN712435OtherMEDICARE PTAN
ND60498Medicaid
ND8HE593Medicare PIN
NDU62166Medicare UPIN