Provider Demographics
NPI:1710968805
Name:MILLER, JOHN DANIEL (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DANIEL
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 1:2170 MIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-2927
Mailing Address - Country:US
Mailing Address - Phone:910-295-2100
Mailing Address - Fax:910-295-3625
Practice Address - Street 1:2170 MIDLAND RD
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-2927
Practice Address - Country:US
Practice Address - Phone:910-295-2100
Practice Address - Fax:910-295-3625
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1155152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC368225OtherUSA MANAGED CARE
NC7909633Medicaid
NC09633OtherBCBS
NC75630OtherMEDCOST
NC2238883OtherUNITED HEALTHCARE
NC332363OtherMAMSI
NCFH7000100OtherFIRSTCAROLINACARE
SCDQ1155Medicaid
NC105591OtherOPTICARE
NC410026224OtherRAILROAD MEDICARE
NC09633OtherBCBS
NC410026224OtherRAILROAD MEDICARE
NC332363OtherMAMSI
SCDQ1155Medicaid