Healthcare Provider Details

I. General information

NPI: 1699732594
Provider Name (Legal Business Name): LAWRENCE DANIEL MILLER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 STATE ROUTE 17M
MONROE NY
10950-4169
US

IV. Provider business mailing address

475 STATE ROUTE 17M PLAZA OPTICAL
MONROE NY
10950-4169
US

V. Phone/Fax

Practice location:
  • Phone: 845-783-4400
  • Fax:
Mailing address:
  • Phone: 845-735-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV005263
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberTUV005263
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: