Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 5055 | OH |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 5055 | OH |
N | 152WP0200X | Pediatric Optomitrist | 5055 | OH |
N | 152WS0006X | Sports Vision | 5055 | OH |
NPI | 1265536403 |
---|---|
Provider Name | Dr. Jason Richard Miller |
First Address | Powell, OH 43065-6100 |
Second Address | Powell, OH 43065-6100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2006 |
Last Update Date | 06/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U76857 | (02) | OH |