Provider Demographics
NPI:1457573537
Name:MILLER, JOSHUA L (OD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:L
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 1:230 SW 43RD ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057
Mailing Address - Country:US
Mailing Address - Phone:425-255-1253
Mailing Address - Fax:425-271-6875
Practice Address - Street 1:230 SW 43RD ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057
Practice Address - Country:US
Practice Address - Phone:425-255-1253
Practice Address - Fax:425-271-6875
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3024152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0102084OtherL & I NUMBER
WA2017630Medicaid
WA71-0911801OtherTAX ID
WA0102084OtherL & I NUMBER
WAGAB34292Medicare ID - Type Unspecified