Provider Demographics
NPI:1679587828
Name:MILLER, KARI JANE (OD)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:JANE
Last Name:MILLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROOKSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56716-1939
Mailing Address - Country:US
Mailing Address - Phone:218-281-2020
Mailing Address - Fax:218-281-5997
Practice Address - Street 1:216 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716-1939
Practice Address - Country:US
Practice Address - Phone:218-281-2020
Practice Address - Fax:218-281-5997
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2368152W00000X
ND512152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN031525700Medicaid
MNU21146Medicare UPIN
MN031525700Medicaid