Provider Demographics
NPI:1952396293
Name:MILLER, EDWARD C (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:C
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 1:260 CRANDON BLVD
Mailing Address - Street 2:SUITE 32-224
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149-1536
Mailing Address - Country:US
Mailing Address - Phone:954-921-7470
Mailing Address - Fax:
Practice Address - Street 1:2914 OAKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-7122
Practice Address - Country:US
Practice Address - Phone:954-921-7470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL0P1768152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078364100Medicaid
FL078364100Medicaid