MEDICARE: DR. TIMOTHY E. 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	046009824	IL
2	152W00000X	Optometrist	56006889	NY
3	152W00000X	Optometrist	OEG001984	PA

General Provider Information

NPI Number	:	1306018874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY E. MILLER O.D.

Provider Business Mailing Address
First Line	:	8614 WESTWOOD CENTER DR FL 9
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-2442
Country	:	US
Telephone Number	:	703-847-8899
Fax Number	:

Provider Business Practice Location Address
First Line	:	3627 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618
Country	:	US
Telephone Number	:	773-525-2022
Fax Number	:	773-525-2024

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

Provider Enumeration Date	:	03/25/2008
Last Update Date	:	03/15/2023

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