Provider Demographics
NPI:1417014937
Name:MILLER, WILLIAM JEFFERY
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JEFFERY
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 REYNOLDA RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106
Mailing Address - Country:US
Mailing Address - Phone:336-724-5000
Mailing Address - Fax:336-723-3341
Practice Address - Street 1:2910 REYNOLDA RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106
Practice Address - Country:US
Practice Address - Phone:336-724-5000
Practice Address - Fax:336-723-3341
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC840152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909618Medicaid
T64588Medicare UPIN
NCNC7637B449Medicare PIN