Provider Demographics
NPI:1568627610
Name:MILLER, TIMOTHY PAUL (OD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:PAUL
Last Name:MILLER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 CIVIC DR
Mailing Address - Street 2:STE G
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-1950
Mailing Address - Country:US
Mailing Address - Phone:925-676-8365
Mailing Address - Fax:925-676-3382
Practice Address - Street 1:395 CIVIC DR
Practice Address - Street 2:STE G
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-1950
Practice Address - Country:US
Practice Address - Phone:925-676-8365
Practice Address - Fax:925-676-3382
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13566152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist