Provider Demographics
NPI:1740220367
Name:MILLER, BYRON RONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:RONALD
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 JACKIE RD
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1566
Mailing Address - Country:US
Mailing Address - Phone:580-255-2501
Mailing Address - Fax:580-255-2117
Practice Address - Street 1:1311 JACKIE RD
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1566
Practice Address - Country:US
Practice Address - Phone:580-255-2501
Practice Address - Fax:580-255-2117
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11524207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100141280AMedicaid
OK100141280AMedicaid
OK731098337Medicare ID - Type Unspecified
OK0630000001Medicare NSC