MEDICARE: DR. WAYNE T MILLER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TUV004438-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10035673-6564	OTHER	NY	CDPHP-HMO
2	906624	OTHER	NY	MVP-HMO

General Provider Information

NPI Number	:	1114913639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE T MILLER O.D.

Provider Business Mailing Address
First Line	:	292 STATE ROUTE 375
Second Line	:
City	:	WEST HURLEY
State	:	NY
Zip	:	12491-5632
Country	:	US
Telephone Number	:	845-679-0393
Fax Number	:	845-679-0390

Provider Business Practice Location Address
First Line	:	292 STATE ROUTE 375
Second Line	:
City	:	WEST HURLEY
State	:	NY
Zip	:	12491-5632
Country	:	US
Telephone Number	:	845-679-0393
Fax Number	:	845-679-0390

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	02/17/2008

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