Organization
KEITH L MILLER, OD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH L MILLER OD (OWNER)
(503) 786-5235
Entity
Organization
Contact information
Practice address
11800 SE 82ND AVE, HAPPY VALLEY, OR 97086-7711
(503) 786-5235
Mailing address
7667 SE LINCOLN ST, PORTLAND, OR 97215-4153
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1865AT
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500691425
—
OR
01
—
R179518
MEDICARE
OR
Enumeration date
10/29/2015
Last updated
10/29/2015
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