Provider Demographics
NPI:1194882704
Name:MILLER, JOAN PLOEM (OD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:PLOEM
Last Name:MILLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 SE BASELINE ST
Mailing Address - Street 2:STE B
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4149
Mailing Address - Country:US
Mailing Address - Phone:503-648-8328
Mailing Address - Fax:503-648-8378
Practice Address - Street 1:527 SE BASELINE ST
Practice Address - Street 2:STE B
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4149
Practice Address - Country:US
Practice Address - Phone:503-648-8328
Practice Address - Fax:503-648-8378
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1455ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORROOWCKDAYMedicare PIN
ORT67924Medicare UPIN