Provider Demographics
NPI:1457700130
Name:SCOTT A MILLER OD, LLC
Entity Type:Organization
Organization Name:SCOTT A MILLER OD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-758-6162
Mailing Address - Street 1:3901 W STATE ROAD 47 STE 5
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:IN
Mailing Address - Zip Code:46069-9256
Mailing Address - Country:US
Mailing Address - Phone:317-758-6162
Mailing Address - Fax:317-758-6163
Practice Address - Street 1:2373 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-2717
Practice Address - Country:US
Practice Address - Phone:317-839-0713
Practice Address - Fax:317-837-4093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003231A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty