Provider Demographics
NPI:1568587327
Name:RICHARD A MILLER OD PC
Entity Type:Organization
Organization Name:RICHARD A MILLER OD PC
Other - Org Name:MILLER VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:906-932-3005
Mailing Address - Street 1:240 ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:IRONWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49938-1737
Mailing Address - Country:US
Mailing Address - Phone:906-932-3005
Mailing Address - Fax:906-932-3188
Practice Address - Street 1:240 ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:IRONWOOD
Practice Address - State:MI
Practice Address - Zip Code:49938-1737
Practice Address - Country:US
Practice Address - Phone:906-932-3005
Practice Address - Fax:906-932-3188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5330000179152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4104809Medicaid
MI900B710380OtherBCNETWORK
MI900B710380OtherBCBSM
MI900B765010OtherMI BCBS
WI38563800Medicaid
MIT32813Medicare UPIN
MI4104809Medicaid
MI1255620001Medicare NSC
MI900B710380OtherBCNETWORK