Provider Demographics
NPI:1881792679
Name:DAYTON VITREO-RETINAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:DAYTON VITREO-RETINAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ABBOTT
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-228-5015
Mailing Address - Street 1:301 W 1ST ST
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-3033
Mailing Address - Country:US
Mailing Address - Phone:937-228-5015
Mailing Address - Fax:937-228-5971
Practice Address - Street 1:301 W 1ST ST
Practice Address - Street 2:SUITE 3A
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-3033
Practice Address - Country:US
Practice Address - Phone:937-228-5015
Practice Address - Fax:937-228-5971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.044810207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000006085OtherANTHEM PIN
OH1147218OtherUMWA PIN
OH50415OtherCIGNA PIN
OH0429923Medicaid
OH4479736OtherAETNA PIN
OH0429923Medicaid
OH=========OtherTRICARE PIN
OH1147218OtherUMWA PIN
OH000000006085OtherANTHEM PIN
OH1147218OtherUMWA PIN