Keith Lyndon Miller, O.D.
Individual provider Active NPI Optometrist · Stevenson, WA
NPI 1962437285 · NPPES record last updated Aug 17, 2012
Key facts
- NPI
- 1962437285
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 602829747 (WA)
- Practice address
- 136 NW Second Street
Stevenson, WA 98648 - Phone
- (509) 427-8259
- Fax
- (509) 427-8268
- NPI assigned
- Jul 12, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WA, OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080605000749 | WA | Practitioner - Optometry | 5294805016 | Reassigns benefits to 1 organization |
| I20150416001513 | OR | Practitioner - Optometry | 5294805016 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 602829747 | WA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mobilitycares Washington LLC | Optometrist | Current |
Accepting new patients |
| Mobilitycares Oregon LLC | Optometrist | Current |
Accepting new patients |
Locations
75 Shore Dr
Saint Helens, OR 97051
Phone (503) 397-2713
2004 N 22nd Ave
Pasco, WA 99301
Phone (208) 995-1122
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 602829747 | WA | Yes |
Addresses
Primary practice location
136 NW Second Street
Stevenson, WA 98648
Mailing address
7667 SE Lincoln St
Portland, OR 97215-4153
Phone (509) 427-8259
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G8873418 | Medicaid | WA |
Other providers in Stevenson, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.