Provider Demographics
NPI:1104849769
Name:MILLER, TERRI L (OD)
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:L
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 1:350 E SUNBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-1868
Mailing Address - Country:US
Mailing Address - Phone:479-442-3838
Mailing Address - Fax:479-442-3838
Practice Address - Street 1:350 E SUNBRIDGE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-1868
Practice Address - Country:US
Practice Address - Phone:479-442-3838
Practice Address - Fax:479-442-3838
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2431152W00000X
OK2124152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR114720OtherEYEMED VISION CARE
AR129015722Medicaid
ARMI722399OtherCLARITY VISION
AR4511960001OtherDURABLE MEDICAL GOODS
ARMI722399OtherCLARITY VISION
AR48833Medicare PIN