Provider Demographics
NPI:1710096516
Name:LESLIE B. MILLER, O.D., INC.
Entity Type:Organization
Organization Name:LESLIE B. MILLER, O.D., INC.
Other - Org Name:TWIN VALLEY EYE ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OPTOMETRIST/ OWNER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:717-625-4600
Mailing Address - Street 1:1555 HIGHLANDS DR
Mailing Address - Street 2:SUITE 180
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-2800
Mailing Address - Country:US
Mailing Address - Phone:717-625-4600
Mailing Address - Fax:717-625-4676
Practice Address - Street 1:1555 HIGHLANDS DR
Practice Address - Street 2:SUITE 180
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-2800
Practice Address - Country:US
Practice Address - Phone:717-625-4600
Practice Address - Fax:717-625-4676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG-001151152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1447077OtherPENNSYLVANIA BLUE SHIELD
PA467786OtherAETNA
PA4739890001Medicare NSC
PA098100Medicare PIN