Provider Demographics
NPI:1639155187
Name:MILLER, NEIL P (OD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:P
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 1:88 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-1860
Mailing Address - Country:US
Mailing Address - Phone:518-891-0680
Mailing Address - Fax:518-891-0683
Practice Address - Street 1:88 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-1860
Practice Address - Country:US
Practice Address - Phone:518-891-0680
Practice Address - Fax:518-891-0683
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0032761152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00523602Medicaid
NY141563057OtherBLUE CROSS SHIELD
0251990001Medicare NSC
U20355Medicare UPIN