Provider Demographics
NPI:1427185073
Name:MILLER, ROBERT S (OWNER)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:MILLER
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43560 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-2436
Mailing Address - Country:US
Mailing Address - Phone:586-254-9600
Mailing Address - Fax:586-254-6787
Practice Address - Street 1:43560 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-2436
Practice Address - Country:US
Practice Address - Phone:586-254-9600
Practice Address - Fax:586-254-6787
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist