Provider Demographics
NPI:1760463582
Name:MILLER, DEAN MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:MICHAEL
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 1:1053 RT. 58
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901
Mailing Address - Country:US
Mailing Address - Phone:631-727-7777
Mailing Address - Fax:
Practice Address - Street 1:1053 ROUTE 58
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2019
Practice Address - Country:US
Practice Address - Phone:631-727-7777
Practice Address - Fax:631-727-7822
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0052712152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
C61251Medicare ID - Type Unspecified