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General NPI Number Information
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NPI Number | 1245402882
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Entity Type | Organization
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Legal Business Name | DENNIS R MILLER, OD
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Dates
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Enumeration Date | 03/24/2008
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Last Update Date | 10/17/2008
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Provider Practice Location Address
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Address Line | 101 W 18TH ST
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City | LA PORTE
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State | IN
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Zip | 46350-6631
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Country | US
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Telephone | 219-326-8855
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Fax | 219-326-8855
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Provider Business Mailing Address
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Address Line | 101 W 18TH ST
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City | LA PORTE
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State | IN
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Zip | 46350-6631
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Country | US
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Telephone | 219-326-8855
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DENNIS R MILLER
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Credential |
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Telephone | 219-326-8855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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