Provider Demographics
NPI:1871666305
Name:MILLER, ROBERT E (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
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 1:13912 NE 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-1465
Mailing Address - Country:US
Mailing Address - Phone:360-574-6030
Mailing Address - Fax:360-574-4116
Practice Address - Street 1:13912 NE 20TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-1465
Practice Address - Country:US
Practice Address - Phone:360-574-6030
Practice Address - Fax:360-574-4116
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001297152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2054609Medicaid
WA000615187OtherMEDICARE ID
WA2054609Medicaid
WAT02585Medicare UPIN