Healthcare Provider Details

I. General information

NPI: 1437179926
Provider Name (Legal Business Name): WAYNE T. MILLER, O.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 STATE ROUTE 375
WEST HURLEY NY
12491-5632
US

IV. Provider business mailing address

292 STATE ROUTE 375
WEST HURLEY NY
12491-5632
US

V. Phone/Fax

Practice location:
  • Phone: 845-679-0393
  • Fax: 845-679-0390
Mailing address:
  • Phone: 845-679-4636
  • Fax: 845-679-0390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV004438-1
License Number StateNY

VIII. Authorized Official

Name: DR. WAYNE THOMAS MILLER
Title or Position: SOLE MEMBER
Credential: O.D.
Phone: 845-679-0393