MEDICARE: JOEL NEUMILLER 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	152WC0802X	Corneal and Contact Management Optometrist	552	ND
2	152WL0500X	Low Vision Rehabilitation Optometrist	552	ND
3	152WP0200X	Pediatric Optometrist	552	ND
4	152WV0400X	Vision Therapy Optometrist	552	ND
5	152WX0102X	Occupational Vision Optometrist	552	ND
6	152W00000X	Optometrist	552	ND

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00717242	OTHER	ND	RAILROAD MEDICARE
4	N712435	OTHER	ND	MEDICARE PTAN

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
2	MEI30952	OTHER	ND	BLUE CROSS BLUE SHIELD OF ND

General Provider Information

NPI Number	:	1568446359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL NEUMILLER O.D.

Provider Business Mailing Address
First Line	:	1801 LONGLEY AVE
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58501-2171
Country	:	US
Telephone Number	:	701-355-4782
Fax Number	:

Provider Business Practice Location Address
First Line	:	2717 ROCK ISLAND PL
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58504-7724
Country	:	US
Telephone Number	:	701-258-3402
Fax Number	:

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

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	07/06/2022

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