Provider Demographics
NPI:1912161803
Name:MILLER, ANN REA (OD)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:REA
Last Name:MILLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1593 ALLENTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2205
Mailing Address - Country:US
Mailing Address - Phone:419-225-3937
Mailing Address - Fax:419-225-3938
Practice Address - Street 1:1593 ALLENTOWN RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2205
Practice Address - Country:US
Practice Address - Phone:419-225-3937
Practice Address - Fax:419-225-3938
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5805T2719152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist