Provider Demographics
NPI:1295832673
Name:MILLER OPTICAL, INC.
Entity Type:Organization
Organization Name:MILLER OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-428-0999
Mailing Address - Street 1:P O BOX 368
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39441
Mailing Address - Country:US
Mailing Address - Phone:601-428-0999
Mailing Address - Fax:601-426-9476
Practice Address - Street 1:1020 ADAMS STREET
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440
Practice Address - Country:US
Practice Address - Phone:601-428-0999
Practice Address - Fax:601-426-9476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0089006Medicaid
MS0407330001Medicare ID - Type Unspecified