Provider Demographics
NPI:1669495040
Name:MILLER ARTIFICIAL EYE LABORATORY, INC.
Entity Type:Organization
Organization Name:MILLER ARTIFICIAL EYE LABORATORY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCULARIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUBBELL
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED OCULARIST
Authorized Official - Phone:419-474-3939
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:419-474-3939
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:419-474-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3-O156FX1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0478648Medicaid
MI54-0-C3-1003-0OtherBCBS ID
OH10170OtherPARAMOUNT ID
MI861670586Medicaid
OH000000029779OtherANTHEM BCBS ID
OH000000029779OtherANTHEM BCBS ID
OH=========00OtherBWC PROVIDER ID