Provider Demographics
NPI:1245237247
Name:MILLER, JAMES E (OPTM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:MILLER
Suffix:
Gender:M
Credentials:OPTM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-1810
Mailing Address - Country:US
Mailing Address - Phone:931-526-2143
Mailing Address - Fax:931-526-5217
Practice Address - Street 1:628 E 10TH ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-1810
Practice Address - Country:US
Practice Address - Phone:931-526-2143
Practice Address - Fax:931-526-5217
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT00751152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3594580Medicare PIN
TN0128830001Medicare NSC
TNT98338Medicare UPIN