Richard A Miller, OD
Individual provider Active NPI Optometrist · Ironwood, MI
NPI 1699720870 · NPPES record last updated Jun 18, 2008
Key facts
- NPI
- 1699720870
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 5330000179 (MI)
- Practice address
- 240 Roosevelt St
Ironwood, MI 49938-1737 - Phone
- (906) 932-3005
- Fax
- (906) 932-3188
- NPI assigned
- May 24, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5330000179 | MI | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Superior Family Vision P.C. | Optometrist | Current |
Accepting new patients |
Locations
240 Roosevelt St
Ironwood, MI 49938
Phone (906) 932-3005
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 5330000179 | MI | Yes |
Addresses
Primary practice location
240 Roosevelt St
Ironwood, MI 49938-1737
Mailing address
240 Roosevelt St
Ironwood, MI 49938-1737
Phone (906) 932-3005
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38563800 | Medicaid | WI | |
| 4104809 | Medicaid | MI | |
| 900B765010 | Other | MI | BLUE CROSS BLUE SHIELD |
Other providers in Ironwood, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 18, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.