Provider Demographics
NPI:1902819410
Name:MILLER, CHARLES F (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:F
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8222 MARBACH RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78227-1618
Mailing Address - Country:US
Mailing Address - Phone:210-675-2301
Mailing Address - Fax:210-675-0900
Practice Address - Street 1:8222 MARBACH RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-1618
Practice Address - Country:US
Practice Address - Phone:210-675-2301
Practice Address - Fax:210-675-0900
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0086207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083748601Medicaid
TX083748601Medicaid
TXB15348Medicare UPIN
TX00L46GMedicare PIN
TX83V240Medicare ID - Type Unspecified