Provider Demographics
NPI:1750376638
Name:MILLER EYE CENTER LTD
Entity type:Organization
Organization Name:MILLER EYE CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-226-1500
Mailing Address - Street 1:2995 EASTROCK DR
Mailing Address - Street 2:PO BOX 7267
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61109-1737
Mailing Address - Country:US
Mailing Address - Phone:815-226-1500
Mailing Address - Fax:815-484-9600
Practice Address - Street 1:2995 EASTROCK DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61109-1737
Practice Address - Country:US
Practice Address - Phone:815-226-1500
Practice Address - Fax:815-484-9600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03606603261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03606603Medicaid
IL0462880001Medicare NSC
IL973200Medicare PIN
IL03606603Medicaid