Healthcare Provider Details

I. General information

NPI: 1275641961
Provider Name (Legal Business Name): ROBERT L. MILLER, OD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4913 WEST MAIN ST
BERLIN OH
44610
US

IV. Provider business mailing address

4913 W. MAIN ST PO BOX 224
BERLIN OH
44610
US

V. Phone/Fax

Practice location:
  • Phone: 330-893-2215
  • Fax: 330-893-3618
Mailing address:
  • Phone: 330-893-2215
  • Fax: 330-893-3618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4371
License Number StateOH

VIII. Authorized Official

Name: DR. ROBERT L MILLER
Title or Position: OPTOMETRIST
Credential: OD
Phone: 330-893-2215