Provider Demographics
NPI:1578506028
Name:MILLER, KEITH BRUMLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:BRUMLEY
Last Name:MILLER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:215 GILEAD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-6821
Mailing Address - Country:US
Mailing Address - Phone:704-992-3937
Mailing Address - Fax:704-464-1488
Practice Address - Street 1:215 GILEAD RD STE 100
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6821
Practice Address - Country:US
Practice Address - Phone:704-992-3937
Practice Address - Fax:704-464-1488
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1056152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7909621Medicaid
NC7909621Medicaid
NC24595Medicare UPIN