Provider Demographics
NPI:1023066925
Name:MILLER, CHRISTOPHER TATE (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:TATE
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 1:1212 PLEASANT ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1414
Mailing Address - Country:US
Mailing Address - Phone:515-244-3937
Mailing Address - Fax:515-243-1442
Practice Address - Street 1:1212 PLEASANT ST
Practice Address - Street 2:SUITE 202
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1414
Practice Address - Country:US
Practice Address - Phone:515-244-3937
Practice Address - Fax:515-243-1442
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02282152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0496752Medicaid
IA15320OtherWELLMARK PROVIDER NUMBER
IA0496182Medicaid
IA04179OtherGROUP ID WELLMARK
IAI17595Medicare PIN
IA15320OtherWELLMARK PROVIDER NUMBER