MEDICARE: DR. LAURENCE IRWIN MILLER D.O.

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	207W00000X	Ophthalmology Physician	33564	MO
2	207W00000X	Ophthalmology Physician	02394	IA
3	207W00000X	Ophthalmology Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	36470	OTHER	IA	BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	13028	OTHER	MO	BC/BS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316937097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURENCE IRWIN MILLER D.O.

Provider Business Mailing Address
First Line	:	506 ROSEWOOD DR
Second Line	:
City	:	KIRKSVILLE
State	:	MO
Zip	:	63501-2437
Country	:	US
Telephone Number	:	660-665-1223
Fax Number	:	660-665-2566

Provider Business Practice Location Address
First Line	:	506 ROSEWOOD DR
Second Line	:
City	:	KIRKSVILLE
State	:	MO
Zip	:	63501-2437
Country	:	US
Telephone Number	:	660-665-1223
Fax Number	:	660-665-2566

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	02/04/2008

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Directions to “ DR. LAURENCE IRWIN MILLER D.O.” Practice Location

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