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General NPI Number Information
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NPI Number | 1578998936
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Entity Type | Individual
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Provider Name | KRYSTLE JO MILLER O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/04/2013
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 3630 IN 26 EAST
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City | LAYFAYETTE
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State | IL
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Zip | 47095
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Country | US
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Telephone | 765-447-5943
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Fax |
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Provider Business Mailing Address
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Address Line | 770 E 3RD STREET
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City | GALESBURG
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State | IL
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Zip | 61401
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Country | US
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Telephone | 309-337-4013
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 046-010696
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18003837A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3606
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046010696
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License Number State | IL
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