Provider Demographics
NPI:1346357423
Name:MILLER, BARI J (OD)
Entity Type:Individual
Prefix:DR
First Name:BARI
Middle Name:J
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 1:4000 SPRING IS
Mailing Address - Street 2:
Mailing Address - City:OKATIE
Mailing Address - State:SC
Mailing Address - Zip Code:29909-4042
Mailing Address - Country:US
Mailing Address - Phone:631-707-3270
Mailing Address - Fax:
Practice Address - Street 1:4000 SPRING IS
Practice Address - Street 2:
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-4042
Practice Address - Country:US
Practice Address - Phone:631-707-3270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4805152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4805OtherLICENSE
NY4805OtherLICENSE