Provider Demographics
NPI:1548365562
Name:MILLER, KEITH C (OD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:C
Last Name:MILLER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11270 LIMA ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:CO
Mailing Address - Zip Code:80640
Mailing Address - Country:US
Mailing Address - Phone:303-386-4567
Mailing Address - Fax:
Practice Address - Street 1:3911 COFFEE RD STE B
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-5024
Practice Address - Country:US
Practice Address - Phone:661-588-8222
Practice Address - Fax:661-588-0222
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2299152W00000X
CA13897TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist