Provider Demographics
NPI:1669603130
Name:MILLER, MATTHEW ALLAN (OD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALLAN
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 1:2020 SEVEN SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-3933
Mailing Address - Country:US
Mailing Address - Phone:727-372-1311
Mailing Address - Fax:727-373-7866
Practice Address - Street 1:2020 SEVEN SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-3933
Practice Address - Country:US
Practice Address - Phone:727-372-1311
Practice Address - Fax:727-373-7866
Is Sole Proprietor?:No
Enumeration Date:2009-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5004152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEP01180750OtherPALMETTO GBA RR MEDICARE PTAN