Provider Demographics
NPI:1578318101
Name:MILLER, BRIAN J (LICENSED OCULARIST)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:MILLER
Suffix:
Gender:M
Credentials:LICENSED OCULARIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 EXECUTIVE PKWY STE 108
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1333
Mailing Address - Country:US
Mailing Address - Phone:419-474-3939
Mailing Address - Fax:419-474-2942
Practice Address - Street 1:3425 EXECUTIVE PKWY STE 108
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1333
Practice Address - Country:US
Practice Address - Phone:419-474-3939
Practice Address - Fax:419-474-3942
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2-O156FX1700X
WAOS61394813156FX1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist