Provider Demographics
NPI:1578998936
Name:MILLER, KRYSTLE JO (OD)
Entity type:Individual
Prefix:DR
First Name:KRYSTLE
Middle Name:JO
Last Name:MILLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KRYSTLE
Other - Middle Name:JO
Other - Last Name:STOCKMASTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:770 E 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401
Mailing Address - Country:US
Mailing Address - Phone:309-337-4013
Mailing Address - Fax:
Practice Address - Street 1:3630 IN 26 EAST
Practice Address - Street 2:
Practice Address - City:LAYFAYETTE
Practice Address - State:IL
Practice Address - Zip Code:47095
Practice Address - Country:US
Practice Address - Phone:765-447-5943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-010696152W00000X
IN18003837A152W00000X
WI3606152W00000X
IL046010696152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist