Healthcare Provider Details

I. General information

NPI: 1477580553
Provider Name (Legal Business Name): ROBERT E MILLER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5393 POST RD
EAST GREENWICH RI
02818-3023
US

IV. Provider business mailing address

10 ORMS ST SUITE 110
PROVIDENCE RI
02904-2228
US

V. Phone/Fax

Practice location:
  • Phone: 401-884-6066
  • Fax: 401-885-2142
Mailing address:
  • Phone: 401-453-0666
  • Fax: 401-453-9619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODTA00309
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODTG00610
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: