Healthcare Provider Details

I. General information

NPI: 1457700130
Provider Name (Legal Business Name): SCOTT A MILLER OD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2373 E MAIN ST
PLAINFIELD IN
46168-2717
US

IV. Provider business mailing address

3901 W STATE ROAD 47 STE 5
SHERIDAN IN
46069-9256
US

V. Phone/Fax

Practice location:
  • Phone: 317-839-0713
  • Fax: 317-837-4093
Mailing address:
  • Phone: 317-758-6162
  • Fax: 317-758-6163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18003231A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SCOTT MILLER
Title or Position: OWNER
Credential: OD
Phone: 317-758-6162