Provider Demographics
NPI:1063475168
Name:MILLER, TERRY W (OD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:W
Last Name:MILLER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 HARRISON RD
Mailing Address - Street 2:
Mailing Address - City:THOMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30824
Mailing Address - Country:US
Mailing Address - Phone:706-595-9533
Mailing Address - Fax:706-595-6512
Practice Address - Street 1:2205 HARRISON RD
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824
Practice Address - Country:US
Practice Address - Phone:706-595-9522
Practice Address - Fax:706-595-6512
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001399152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000935316AMedicaid
GA41ZCDWWMedicare ID - Type UnspecifiedT.MILLER
GA000935316AMedicaid