Provider Demographics
NPI:1932245248
Name:MILLER, MERRILL THOMAS (OD)
Entity type:Individual
Prefix:DR
First Name:MERRILL
Middle Name:THOMAS
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 1:303 TEACO RD
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-3237
Mailing Address - Country:US
Mailing Address - Phone:573-888-5896
Mailing Address - Fax:573-888-1501
Practice Address - Street 1:303 TEACO RD
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-3237
Practice Address - Country:US
Practice Address - Phone:573-888-5896
Practice Address - Fax:573-888-1501
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2025-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02701152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5514370001OtherNORIDIAN ADM SERVICES
MO191843OtherBLUE CROSS BLUE SHIELD
MOT42614Medicare UPIN