Provider Demographics
NPI:1730143439
Name:MILLER, SHEILA M (OD)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:M
Other - Last Name:COPPOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426
Mailing Address - Country:US
Mailing Address - Phone:207-564-8011
Mailing Address - Fax:207-564-3112
Practice Address - Street 1:31 NORTH ST
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426
Practice Address - Country:US
Practice Address - Phone:207-564-8011
Practice Address - Fax:207-564-3112
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT564152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T31716Medicare UPIN
709541Medicare ID - Type Unspecified