Provider Demographics
NPI:1144301219
Name:MILLER, JOSEPH ALLEN (OD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ALLEN
Last Name:MILLER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12050 PARK BLVD
Mailing Address - Street 2:APT 247
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-4560
Mailing Address - Country:US
Mailing Address - Phone:727-804-5795
Mailing Address - Fax:
Practice Address - Street 1:BAY PINES VETERANS AFFAIRS MEDICAL CENTER
Practice Address - Street 2:10000 BAY PINES BLVD
Practice Address - City:BAY PINES
Practice Address - State:FL
Practice Address - Zip Code:33744
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1261152W00000X
FLOPC 4199152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist