Provider Demographics
NPI:1427044668
Name:MILLER, ALLISON H (OD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:H
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 1:657 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3903
Mailing Address - Country:US
Mailing Address - Phone:731-660-3937
Mailing Address - Fax:731-424-3789
Practice Address - Street 1:657 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3903
Practice Address - Country:US
Practice Address - Phone:731-660-3937
Practice Address - Fax:731-424-3789
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2217152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU82485Medicare UPIN
TN3945388Medicare ID - Type Unspecified