Provider Demographics
NPI:1134104771
Name:MILLER, CHARLES D (OD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:D
Last Name:MILLER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:2616 LAWNDALE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-4800
Mailing Address - Country:US
Mailing Address - Phone:336-288-1919
Mailing Address - Fax:336-545-1931
Practice Address - Street 1:2616 LAWNDALE DR
Practice Address - Street 2:SUITE A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4800
Practice Address - Country:US
Practice Address - Phone:336-288-1919
Practice Address - Fax:336-545-1931
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC1035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC22027058OtherUNITED HEALTH CARE
NC21944OtherPARTNERS
NC73917OtherMEDCOST
NC093F2OtherBCBS
NC6271257OtherCIGNA
NC0327310001OtherDMERC SUPPLIER NUMBER
NC89093F2Medicaid
NC410047496OtherRAILROAD
NC410047496OtherRAILROAD
NC6271257OtherCIGNA