Provider Demographics
NPI:1821038050
Name:MILLER, RICHARD ALLAN (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLAN
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 1:302 W MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-4140
Mailing Address - Country:US
Mailing Address - Phone:614-873-1003
Mailing Address - Fax:
Practice Address - Street 1:302 W MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PLAIN CITY
Practice Address - State:OH
Practice Address - Zip Code:43064-4140
Practice Address - Country:US
Practice Address - Phone:614-873-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4217/T949152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH300028432OtherTRICARE
OH000000224728OtherANTHEM
OH2200301OtherUNITED HEALTHCARE
OH5452035OtherAETNA
OHP00142870OtherRAILROAD MEDICARE
OH0862204Medicaid
OHU19570Medicare UPIN
OH000000224728OtherANTHEM
OH300028432OtherTRICARE