Provider Demographics
NPI:1851356174
Name:MILLER, STEVEN A (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:A
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 1:34806 YUCAIPA BLVD
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-4235
Mailing Address - Country:US
Mailing Address - Phone:909-797-0134
Mailing Address - Fax:909-797-0137
Practice Address - Street 1:34806 YUCAIPA BLVD
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-4235
Practice Address - Country:US
Practice Address - Phone:909-797-0134
Practice Address - Fax:909-797-0137
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7527T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA410001190OtherRAILROAD MEDICARE
CAMM0895207OtherDEA #
CA410001190OtherRAILROAD MEDICARE
T10551Medicare UPIN
CAMM0895207OtherDEA #
CA0350010001Medicare NSC
CAZZZ20479ZMedicare ID - Type Unspecified