MEDICARE: ROBERT L. MILLER, OD INC.

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	4371	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225040868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT L. MILLER, OD INC.

Provider Business Mailing Address
First Line	:	500 S PROSPECT AVE
Second Line	:
City	:	HARTVILLE
State	:	OH
Zip	:	44632-9403
Country	:	US
Telephone Number	:	330-877-2117
Fax Number	:	330-877-1617

Provider Business Practice Location Address
First Line	:	500 S PROSPECT AVE
Second Line	:
City	:	HARTVILLE
State	:	OH
Zip	:	44632-9403
Country	:	US
Telephone Number	:	330-877-2117
Fax Number	:	330-877-1617

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT L MILLER
Credential	:	OD
Telephone Number	:	330-877-2117

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	08/22/2020

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