Provider Demographics
NPI:1518933043
Name:MILLER, SUSAN HARRINGTON (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:HARRINGTON
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 1:204 W CHESTNUT ST
Mailing Address - Street 2:PO BOX 47
Mailing Address - City:BUTLER
Mailing Address - State:MO
Mailing Address - Zip Code:64730-1554
Mailing Address - Country:US
Mailing Address - Phone:660-679-3261
Mailing Address - Fax:660-679-6213
Practice Address - Street 1:204 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:MO
Practice Address - Zip Code:64730-1554
Practice Address - Country:US
Practice Address - Phone:660-679-3261
Practice Address - Fax:660-679-6213
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03247152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO318165117Medicaid
MO22386037OtherBLUECROSSBLUESHIELD
MOJ439991Medicare ID - Type UnspecifiedOPTOMETRIST
MO318165117Medicaid