Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 18001871A | IN |
NPI | 1003819442 |
---|---|
Provider Name | Dennis R Miller |
First Address | Warsaw, IN 46580-3212 |
Second Address | Warsaw, IN 46580-3212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 05/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100324560B | (05) | IN |
100342560 | (05) | IN |
U09527 | (02) | IN |