Provider Demographics
NPI:1073617304
Name:MILLER, DAVID HUNTER (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:HUNTER
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 1:9409 S NORTHSHORE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-6550
Mailing Address - Country:US
Mailing Address - Phone:865-694-2622
Mailing Address - Fax:865-694-2650
Practice Address - Street 1:9409 S NORTHSHORE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-6550
Practice Address - Country:US
Practice Address - Phone:865-694-2622
Practice Address - Fax:865-694-2650
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2009-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTNOD1234152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3598809Medicare PIN