Provider Demographics
NPI:1760404941
Name:MILLER, ERIC R (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:R
Last Name:MILLER
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 1:57 JENNERS VILLAGE CENTER
Mailing Address - Street 2:
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9189
Mailing Address - Country:US
Mailing Address - Phone:610-869-4200
Mailing Address - Fax:
Practice Address - Street 1:57 JENNERS VILLAGE CENTER
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9189
Practice Address - Country:US
Practice Address - Phone:610-869-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000294152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019738240001Medicaid
U63433Medicare UPIN
028833Q59Medicare ID - Type Unspecified
PA4753500001Medicare NSC