Provider Demographics
NPI:1932584331
Name:MILLER, ANDREW W (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:W
Last Name:MILLER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1010 LIGONIER ST
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1846
Mailing Address - Country:US
Mailing Address - Phone:724-539-1671
Mailing Address - Fax:724-539-1654
Practice Address - Street 1:1010 LIGONIER ST
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1846
Practice Address - Country:US
Practice Address - Phone:724-539-1671
Practice Address - Fax:724-539-1654
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003046152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030863150001Medicaid
PA182875771OtherRAILROAD MEDICARE GROUP PTAN
PA003326584OtherHIGHMARK
PA1295789725OtherMEDICARE