Provider Demographics
NPI:1326536335
Name:MILLER, MARK JAY (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JAY
Last Name:MILLER
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 SIPLER LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-3223
Mailing Address - Country:US
Mailing Address - Phone:215-370-5431
Mailing Address - Fax:
Practice Address - Street 1:3617 SIPLER LN
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-3223
Practice Address - Country:US
Practice Address - Phone:215-370-5431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician