Provider Demographics
NPI:1265536403
Name:MILLER, JASON RICHARD (OD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:RICHARD
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 1:265 N LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-8870
Mailing Address - Country:US
Mailing Address - Phone:614-793-0700
Mailing Address - Fax:614-793-0084
Practice Address - Street 1:9711 SAWMILL PKWY UNIT C
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-6100
Practice Address - Country:US
Practice Address - Phone:614-793-0700
Practice Address - Fax:614-793-0084
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5055152WP0200X, 152WS0006X, 152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMI0890261Medicare ID - Type Unspecified
OHU76857Medicare UPIN