Healthcare Provider Details

I. General information

NPI: 1609051077
Provider Name (Legal Business Name): MARTIN F. MILLER, O.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 E WESNER RD
BLANDON PA
19510-9729
US

IV. Provider business mailing address

PO BOX 56
BLANDON PA
19510-0056
US

V. Phone/Fax

Practice location:
  • Phone: 610-926-4241
  • Fax: 610-926-8160
Mailing address:
  • Phone: 610-926-4241
  • Fax: 610-926-8160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StatePA

VIII. Authorized Official

Name: DR. MARTIN F. MILLER
Title or Position: OWNER
Credential: O.D.
Phone: 610-926-4241