Healthcare Provider Details

I. General information

NPI: 1568627610
Provider Name (Legal Business Name): TIMOTHY PAUL MILLER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 CLAYTON RD
CONCORD CA
94519-2833
US

IV. Provider business mailing address

3325 CLAYTON RD
CONCORD CA
94519-2833
US

V. Phone/Fax

Practice location:
  • Phone: 925-687-6847
  • Fax: 925-687-6847
Mailing address:
  • Phone: 925-687-6847
  • Fax: 925-687-6847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13566
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: