Healthcare Provider Details

I. General information

NPI: 1821038050
Provider Name (Legal Business Name): RICHARD ALLAN MILLER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W MAIN ST SUITE 100
PLAIN CITY OH
43064-4140
US

IV. Provider business mailing address

302 W MAIN ST SUITE 100
PLAIN CITY OH
43064-4140
US

V. Phone/Fax

Practice location:
  • Phone: 614-873-1003
  • Fax:
Mailing address:
  • Phone: 614-873-1003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4217/T949
License Number StateOH

VII. Legacy identifiers

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

# 1
Identifier300028432
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerTRICARE
# 2
Identifier000000224728
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerANTHEM
# 3
Identifier2200301
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerUNITED HEALTHCARE
# 4
Identifier5452035
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerAETNA
# 5
IdentifierP00142870
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerRAILROAD MEDICARE
# 6
Identifier0862204
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: