Provider Demographics
NPI:1710005632
Name:MILLER, CHANI (OD)
Entity Type:Individual
Prefix:DR
First Name:CHANI
Middle Name:
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 1:18 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2408
Mailing Address - Country:US
Mailing Address - Phone:732-993-1111
Mailing Address - Fax:732-993-1167
Practice Address - Street 1:18 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2408
Practice Address - Country:US
Practice Address - Phone:732-993-1111
Practice Address - Fax:732-993-1167
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00523800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6511708Medicaid
NJU56370Medicare UPIN
NJ776481Medicare ID - Type Unspecified