MEDICARE: LAURENCE I. MILLER, D.O., PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	33564	MO

General Provider Information

NPI Number	:	1316026107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAURENCE I. MILLER, D.O., PA

Provider Business Mailing Address
First Line	:	506 ROSEWOOD DR
Second Line	:
City	:	KIRKSVILLE
State	:	MO
Zip	:	63501-2437
Country	:	US
Telephone Number	:	660-665-1223
Fax Number	:	660-665-2566

Provider Business Practice Location Address
First Line	:	506 ROSEWOOD DR
Second Line	:
City	:	KIRKSVILLE
State	:	MO
Zip	:	63501-2437
Country	:	US
Telephone Number	:	660-665-1223
Fax Number	:	660-665-2566

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LAURENCE IRWIN MILLER
Credential	:	D.O.
Telephone Number	:	660-665-1223

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	08/22/2020

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