Provider Demographics
NPI:1235410275
Name:MILLER, JULAYNE ANNE (OD)
Entity Type:Individual
Prefix:
First Name:JULAYNE
Middle Name:ANNE
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 1:105 W HARVEST RD
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:IN
Mailing Address - Zip Code:46714-9007
Mailing Address - Country:US
Mailing Address - Phone:260-824-3424
Mailing Address - Fax:
Practice Address - Street 1:105 W HARVEST RD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-9007
Practice Address - Country:US
Practice Address - Phone:260-824-3424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-05
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003685152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist