Active NPI
Kelsey Jane Miller
- Optometrist
- Broomall, PA
National Provider Identifier
1427749589
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OEG004018
- Practice address
- 1991 Sproul Rd Ste 28
Broomall, PA 19008-3514 - Phone
- (770) 822-3600
- NPI assigned
- May 18, 2023
- Last updated
- Jun 19, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OEG004018 | PA | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
1991 Sproul Rd Ste 28
Broomall, PA 19008-3514
Mailing address
115 Gilead Rd
Bloomfield, ONTARIO K0K1G0
CA
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OEG004018 | PA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684368000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687132800000",
"number": "1427749589",
"addresses": [
{
"country_code": "CA",
"country_name": "Canada",
"address_purpose": "MAILING",
"address_type": "FGN",
"address_1": "115 GILEAD RD",
"city": "BLOOMFIELD",
"state": "ONTARIO",
"postal_code": "K0K1G0"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1991 SPROUL RD STE 28",
"city": "BROOMALL",
"state": "PA",
"postal_code": "190083514",
"telephone_number": "770-822-3600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "KELSEY",
"middle_name": "JANE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-05-18",
"last_updated": "2023-06-19",
"certification_date": "2023-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "PA",
"license": "OEG004018",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Broomall, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.