Shawn Ryan Miller, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901004911 Issued in MI

Practice address

929 Business Park Dr
Traverse City, MI 49686

Phone

(231) 487-2020

Fax

(231) 487-6166

NPI assigned

Jun 25, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Grand Traverse Ophthalmology Clinic PCGroup PAC ID 4981503521, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: smiller@direct.gtoc.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grand Traverse Ophthalmology Clinic PC

  • Ophthalmology Physician
  • Traverse City, MI
  • NPI 1265426514
  Medicare reassignment Care Compare group
• Indiana University

  • Optometrist
  • Indianapolis, IN
  • NPI 1497799787
  NPD (past)

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

{
    "created_epoch": "1403654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712102400000",
    "number": "1902211295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "929 BUSINESS PARK DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496868683",
            "telephone_number": "231-947-6246",
            "fax_number": "231-947-8864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "929 BUSINESS PARK DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "49686",
            "telephone_number": "231-487-2020",
            "fax_number": "231-487-6166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "SHAWN",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-25",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004911",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Miller, MSW
• Laura Miller, LMSW
• Nicholas Jon Miller, MD
• Sally Miller, DO
• Sarah Danielle Miller, DPM
• Shelby Nicole Miller, LMT
• Susan Kae Miller, OTR
• Travis Miller, PHARMD
• Milliken Medical PLLC
• John P Milliken, MD

• Optometrist in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.