Provider Demographics
NPI:1013014646
Name:MILLER, SUSAN E (OD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
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 1:8501 TURNPIKE DR
Mailing Address - Street 2:#105
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-7041
Mailing Address - Country:US
Mailing Address - Phone:303-427-1426
Mailing Address - Fax:303-427-5220
Practice Address - Street 1:8501 TURNPIKE DR
Practice Address - Street 2:#105
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-7041
Practice Address - Country:US
Practice Address - Phone:303-427-1426
Practice Address - Fax:303-427-5220
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1909152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO38729831Medicaid
CO486318Medicare ID - Type UnspecifiedMEDICARE