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General NPI Number Information
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NPI Number | 1972667764
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Entity Type | Individual
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Provider Name | SUSAN K MILLER O.D.
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Gender | Female
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 03/09/2010
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Provider Practice Location Address
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Address Line | 3700 RIVERTOWN PKWY SW SPACE 2112 RIVERTOWN CROSSINGS
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City | GRANDVILLE
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State | MI
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Zip | 49418-3085
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Country | US
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Telephone | 616-249-7362
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Fax | 616-249-8097
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Provider Business Mailing Address
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Address Line | 1468 JULIE CT
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City | HUDSONVILLE
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State | MI
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Zip | 49426-9582
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Country | US
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Telephone | 616-667-1853
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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 | 4901003738
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License Number State | MI
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