Basic Information
Provider Information
NPI: 1861804825
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MILLER
FirstName: MATTHEW
MiddleName: A
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 200 HAWKINS DR
Address2: DEPT OF OPHTHALMOLOGY & VISUAL SCIENCES
City: IOWA CITY
State: IA
PostalCode: 522421009
CountryCode: US
TelephoneNumber: 3193563938
FaxNumber: 3193561520
Practice Location
Address1: 200 HAWKINS DR
Address2: DEPT OF OPHTHALMOLOGY & VISUAL SCIENCES
City: IOWA CITY
State: IA
PostalCode: 52242
CountryCode: US
TelephoneNumber: 3193563938
FaxNumber: 3193561520
Other Information
ProviderEnumerationDate: 05/27/2014
LastUpdateDate: 06/24/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207W00000XMD-31343IAY Allopathic & Osteopathic PhysiciansOphthalmology 
207W00000XR-09976IAN Allopathic & Osteopathic PhysiciansOphthalmology 
207WX0009XMD-31343IAN    

No ID Information.


Home