Provider Demographics
NPI:1932455722
Name:MILLER, REBECCA R (OD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:HANNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4000 BRYANT IRVIN RD STE 216
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4153
Mailing Address - Country:US
Mailing Address - Phone:682-267-2020
Mailing Address - Fax:682-244-2204
Practice Address - Street 1:4000 BRYANT IRVIN RD STE 216
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4153
Practice Address - Country:US
Practice Address - Phone:682-267-2020
Practice Address - Fax:682-244-2204
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8047TG152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist