Healthcare Provider Details

I. General information

NPI: 1518933043
Provider Name (Legal Business Name): SUSAN HARRINGTON MILLER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W CHESTNUT ST
BUTLER MO
64730-1554
US

IV. Provider business mailing address

204 W CHESTNUT ST PO BOX 47
BUTLER MO
64730-1554
US

V. Phone/Fax

Practice location:
  • Phone: 660-679-3261
  • Fax: 660-679-6213
Mailing address:
  • Phone: 660-679-3261
  • Fax: 660-679-6213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT03247
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: