Provider Demographics
NPI:1851433148
Name:MILLER, KAREN L (OD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11558-1823
Mailing Address - Country:US
Mailing Address - Phone:516-777-0010
Mailing Address - Fax:516-744-7298
Practice Address - Street 1:670 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2237
Practice Address - Country:US
Practice Address - Phone:516-777-0010
Practice Address - Fax:516-744-7298
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006540152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU94507Medicare UPIN
NYC246G1Medicare ID - Type Unspecified