Provider Demographics
NPI:1033105150
Name:MILLER, PAMELA JOYCE LARAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JOYCE LARAYNE
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 1:6836 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-2513
Mailing Address - Country:US
Mailing Address - Phone:909-862-4053
Mailing Address - Fax:603-816-9547
Practice Address - Street 1:6836 PALM AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-2513
Practice Address - Country:US
Practice Address - Phone:909-862-4053
Practice Address - Fax:603-816-9547
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5569T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0055690Medicaid
SD0055690Medicare PIN
CASD0055690Medicare ID - Type Unspecified
6243040001Medicare NSC
T10042-9Medicare UPIN