Provider Demographics
NPI:1760403190
Name:MILLER, JEFFREY D (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:MILLER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10 CAPITAL DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110
Mailing Address - Country:US
Mailing Address - Phone:717-233-3937
Mailing Address - Fax:717-233-5715
Practice Address - Street 1:10 CAPITAL DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110
Practice Address - Country:US
Practice Address - Phone:717-233-3937
Practice Address - Fax:717-233-5715
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000692152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
467508KFLMedicare ID - Type Unspecified
PAU46079Medicare UPIN