Provider Demographics
NPI:1609051077
Name:MARTIN F. MILLER, O.D.
Entity type:Organization
Organization Name:MARTIN F. MILLER, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-926-4241
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:BLANDON
Mailing Address - State:PA
Mailing Address - Zip Code:19510-0056
Mailing Address - Country:US
Mailing Address - Phone:610-926-4241
Mailing Address - Fax:610-926-8160
Practice Address - Street 1:219 E WESNER RD
Practice Address - Street 2:
Practice Address - City:BLANDON
Practice Address - State:PA
Practice Address - Zip Code:19510-9729
Practice Address - Country:US
Practice Address - Phone:610-926-4241
Practice Address - Fax:610-926-8160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT27668Medicare UPIN
PA0346910001Medicare NSC