Provider Demographics
NPI:1518957620
Name:MILLER, BILLY D
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:D
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 1:821 N YORK ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-3871
Mailing Address - Country:US
Mailing Address - Phone:918-686-6446
Mailing Address - Fax:918-686-6140
Practice Address - Street 1:821 N YORK ST
Practice Address - Street 2:SUITE E
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-3871
Practice Address - Country:US
Practice Address - Phone:918-686-6446
Practice Address - Fax:918-686-6140
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1181152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100762510CMedicaid
300522197Medicare PIN
OK5654120001Medicare NSC
T40572Medicare UPIN
OKP00336240Medicare PIN