Provider Demographics
NPI:1154397719
Name:MILLER, PETER LAWRENCE (OD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:LAWRENCE
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 1:1400 SANTA RITA RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-5666
Mailing Address - Country:US
Mailing Address - Phone:925-846-4364
Mailing Address - Fax:925-846-7825
Practice Address - Street 1:1400 SANTA RITA RD
Practice Address - Street 2:SUITE B
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-5666
Practice Address - Country:US
Practice Address - Phone:925-846-4364
Practice Address - Fax:925-846-7825
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9882T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0098820Medicare ID - Type Unspecified
CAU74834Medicare UPIN