Provider Demographics
NPI:1043215940
Name:MILLER, BEVERLY (OD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:
Other - Last Name:THOMSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10 CODINGTON PL
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2408
Mailing Address - Country:US
Mailing Address - Phone:908-725-0144
Mailing Address - Fax:908-722-6785
Practice Address - Street 1:10 CODINGTON PL
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2408
Practice Address - Country:US
Practice Address - Phone:908-725-0144
Practice Address - Fax:908-722-6785
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00293200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ261569654OtherQUALCARE
NJ510341OtherAETNA
NJ261569654OtherVSP
NJ261569654OtherHORIZON BLUE CROSS/SHIELD
NJ261569654OtherBEECH STREET
NJ261569654OtherUNITED HEALTHCARE
NJ261569654OtherCIGNA
NJU18742Medicare UPIN
NJ521337Medicare PIN