Keith L Miller, OD, PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

1865AT Issued in OR

Legal business name

KEITH L MILLER, OD, PC

Practice address

11800 SE 82ND Ave
Happy Valley, OR 97086-7711

Phone

(503) 786-5235

NPI assigned

Oct 29, 2015

Last updated

Oct 29, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Keith L Miller, OD

Title

Owner

Phone

(503) 786-5235

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1446076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446076800000",
    "number": "1023480050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7667 SE LINCOLN ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972154153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11800 SE 82ND AVE",
            "city": "HAPPY VALLEY",
            "state": "OR",
            "postal_code": "970867711",
            "telephone_number": "503-786-5235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEITH L MILLER, OD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-29",
        "last_updated": "2015-10-29",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-786-5235",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "1865AT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "R179518",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500691425",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn Jungblut
• Steven Jay Justice, D.D.S.
• Kaiser Foundation Health Plan of the Northwest (Johnson Creek Dental Office)
• Catherine Kanda, DC
• Kristi Keats, FNP-C
• Keith Miller OD PC
• Carol Ann Keller, RPH
• Joshua Benjamin Kelso
• Darcy Brook Kennedy, LCSW
• Holly Michelle Kiesz-Royer, SLP

• Optometrist in Happy Valley, OR
• Providers in Happy Valley, OR by specialty
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.