Provider Demographics
NPI:1437179926
Name:WAYNE T. MILLER, O.D., PLLC
Entity type:Organization
Organization Name:WAYNE T. MILLER, O.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:845-679-0393
Mailing Address - Street 1:292 STATE ROUTE 375
Mailing Address - Street 2:
Mailing Address - City:WEST HURLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12491-5632
Mailing Address - Country:US
Mailing Address - Phone:845-679-4636
Mailing Address - Fax:845-679-0390
Practice Address - Street 1:292 STATE ROUTE 375
Practice Address - Street 2:
Practice Address - City:WEST HURLEY
Practice Address - State:NY
Practice Address - Zip Code:12491-5632
Practice Address - Country:US
Practice Address - Phone:845-679-0393
Practice Address - Fax:845-679-0390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004438-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY100356736564OtherHMO
NY906624OtherHMO
NYC3323CBTR1Medicare PIN
NY100356736564OtherHMO
NY5711540001Medicare NSC
NYCBWTR1Medicare PIN