MEDICARE: DR LARRY R MILLER ASSOC PSC

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	1116DT	KY

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	:	1649563743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR LARRY R MILLER ASSOC PSC

Provider Business Mailing Address
First Line	:	3650 BOSTON RD
Second Line	:	STE 184
City	:	LEXINGTON
State	:	KY
Zip	:	40514-1569
Country	:	US
Telephone Number	:	859-296-5557
Fax Number	:	859-224-7766

Provider Business Practice Location Address
First Line	:	3650 BOSTON RD
Second Line	:	STE 184
City	:	LEXINGTON
State	:	KY
Zip	:	40514-1569
Country	:	US
Telephone Number	:	859-296-5557
Fax Number	:	859-224-7766

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LARRY R MILLER
Credential	:
Telephone Number	:	859-296-5557

Provider Enumeration Date	:	05/23/2011
Last Update Date	:	05/26/2011

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