Provider Demographics
NPI:1649320441
Name:MILLER OPTOMETRISTS INC
Entity type:Organization
Organization Name:MILLER OPTOMETRISTS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:GRONE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-692-0010
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-0159
Mailing Address - Country:US
Mailing Address - Phone:419-692-0010
Mailing Address - Fax:419-695-4533
Practice Address - Street 1:134 E 3RD ST
Practice Address - Street 2:
Practice Address - City:DELPHOS
Practice Address - State:OH
Practice Address - Zip Code:45833-1761
Practice Address - Country:US
Practice Address - Phone:419-692-0010
Practice Address - Fax:419-695-4533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4625OH152W00000X
OH3030H152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0157888Medicaid
OH0265510Medicaid
OH9275361Medicare ID - Type UnspecifiedGROUP PROVIDER #
OH0265510Medicaid