Provider Demographics
NPI:1942487723
Name:MILLER, LYNN L (OD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:BILLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22757 WOODWARD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1778
Mailing Address - Country:US
Mailing Address - Phone:248-399-9595
Mailing Address - Fax:248-399-9597
Practice Address - Street 1:8130 LOCKLIN LN
Practice Address - Street 2:
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-2225
Practice Address - Country:US
Practice Address - Phone:734-769-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003714152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN26930192Medicaid