Provider Demographics
NPI:1710953500
Name:NEWMAN, MILES JEFFERY (OD)
Entity Type:Individual
Prefix:DR
First Name:MILES
Middle Name:JEFFERY
Last Name:NEWMAN
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 1:5049A VALLEY VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-2075
Mailing Address - Country:US
Mailing Address - Phone:540-362-7565
Mailing Address - Fax:540-563-0441
Practice Address - Street 1:5049 VALLEY VIEW BLVD NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-2074
Practice Address - Country:US
Practice Address - Phone:540-362-7565
Practice Address - Fax:540-563-0441
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000274152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009204695Medicaid
VA009204695Medicaid
VA1710953500Medicare PIN