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General NPI Number Information
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NPI Number | 1568587327
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Entity Type | Organization
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Legal Business Name | RICHARD A MILLER OD PC
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 05/08/2009
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Provider Practice Location Address
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Address Line | 240 ROOSEVELT ST
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City | IRONWOOD
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State | MI
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Zip | 49938-1737
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Country | US
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Telephone | 906-932-3005
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Fax | 906-932-3188
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Provider Business Mailing Address
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Address Line | 240 ROOSEVELT ST
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City | IRONWOOD
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State | MI
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Zip | 49938-1737
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Country | US
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Telephone | 906-932-3005
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Fax | 906-932-3188
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. RICHARD A MILLER
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Credential | OD
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Telephone | 906-932-3005
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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 | 5330000179
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License Number State | MI
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