Provider Demographics
NPI:1417206913
Name:MILLER, BRETT ASHTON (OD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:ASHTON
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 1:2216 E NC HIGHWAY 54
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-2208
Mailing Address - Country:US
Mailing Address - Phone:919-544-2020
Mailing Address - Fax:919-433-0298
Practice Address - Street 1:8111 CREEDMOOR RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-4389
Practice Address - Country:US
Practice Address - Phone:919-301-8866
Practice Address - Fax:919-896-6502
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2294152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy