Provider Demographics
NPI:1346216959
Name:MILLER, LESLIE BEARD (OD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:BEARD
Last Name:MILLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LESLIE
Other - Middle Name:GAYLE
Other - Last Name:BEARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:16 HORSESHOE DR
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-8811
Mailing Address - Country:US
Mailing Address - Phone:717-733-7982
Mailing Address - Fax:
Practice Address - Street 1:1555 HIGHLANDS DR
Practice Address - Street 2:SUITE 180
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-2800
Practice Address - Country:US
Practice Address - Phone:717-625-4600
Practice Address - Fax:717-625-4676
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG0001151152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
467786OtherAETNA
1447707OtherHIGHMARK BLUE SHIELD
1447707OtherHIGHMARK BLUE SHIELD
PA098100Medicare PIN