Provider Demographics
NPI:1477616423
Name:MILLER, STANLEY DAVID (OD, MS, FAAO)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:DAVID
Last Name:MILLER
Suffix:
Gender:M
Credentials:OD, MS, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BEMIS ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-1701
Mailing Address - Country:US
Mailing Address - Phone:781-899-7751
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:56 COLPITTS RD
Practice Address - Street 2:EYE & OPTICAL
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-1568
Practice Address - Country:US
Practice Address - Phone:781-899-7751
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2263152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
757526OtherTUFTS HEALTH PLAN ID
MAW15986OtherBCBS OF MASS
MA0891138 OR B2119401OtherCIGNA HEALTH CARE
2569545OtherUS HEALTH AETNA
MA152625OtherHARVARD PILGRIM HEALTH