Provider Demographics
NPI:1699868430
Name:MILLER, JOSEPH ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ALAN
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 1:222 1ST SE
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1567
Mailing Address - Country:US
Mailing Address - Phone:218-631-2020
Mailing Address - Fax:218-631-1892
Practice Address - Street 1:222 1ST ST SE
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1567
Practice Address - Country:US
Practice Address - Phone:218-631-2020
Practice Address - Fax:218-631-1892
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2009-05-19
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-12-05
Provider Licenses
StateLicense IDTaxonomies
MN1716152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1N069MIOtherBLUE PLUS
MN999995764OtherVSP
MN2216300OtherMEDICA
MN1N069MIOtherBLUECROSS BLUESHIELD
MN1N069MIOtherSOUTH COUNTRY ALLIANCE
MN1010299OtherPREFERRED ONE
MNHP34820OtherHEALTHPARTNERS
MNMN1716OtherEYEMED
MN410000988Medicaid
MN1010299OtherPREFERRED ONE
MN1N069MIOtherBLUE PLUS
MN410000988Medicaid