Provider Demographics
NPI:1649563743
Name:DR LARRY R MILLER ASSOC PSC
Entity type:Organization
Organization Name:DR LARRY R MILLER ASSOC PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-296-5557
Mailing Address - Street 1:3650 BOSTON RD
Mailing Address - Street 2:STE 184
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1569
Mailing Address - Country:US
Mailing Address - Phone:859-296-5557
Mailing Address - Fax:859-224-7766
Practice Address - Street 1:3650 BOSTON RD
Practice Address - Street 2:STE 184
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40514-1569
Practice Address - Country:US
Practice Address - Phone:859-296-5557
Practice Address - Fax:859-224-7766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-23
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1116DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77011161Medicaid
KYT54756KYMedicare UPIN