Keith Miller OD PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

1654AT Issued in OR

Legal business name

KEITH MILLER OD PC

Practice address

11800 SE 82ND Ave
Happy Valley, OR 97086

Phone

(503) 786-5235

Fax

(503) 654-5429

NPI assigned

Jun 2, 2008

Last updated

Sep 29, 2016By 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 Miller, OD

Title

Owner

Phone

(503) 860-6399

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1212364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475107200000",
    "number": "1760641138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11800 SE 82ND AVE",
            "city": "HAPPY VALLEY",
            "state": "OR",
            "postal_code": "97086",
            "telephone_number": "503-786-5235",
            "fax_number": "503-654-5429"
        },
        {
            "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": "97086",
            "telephone_number": "503-786-5235",
            "fax_number": "503-654-5429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEITH MILLER OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-02",
        "last_updated": "2016-09-29",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-860-6399",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00003109",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "1654AT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500691425",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• 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 L Miller, OD, PC
• Carol Ann Keller, RPH
• Joshua Benjamin Kelso
• Darcy Brook Kennedy, LCSW
• Holly Michelle Kiesz-Royer, SLP
• King Smile Dentistry LLC (King Smile Dentistry)

• 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 Sep 29, 2016; 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.