Provider Demographics
NPI:1205285780
Name:MILLER, DANIEL JUSTIN (OD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JUSTIN
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 1:1000 JOHNNIE DODDS BLVD STE 103-190
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3135
Mailing Address - Country:US
Mailing Address - Phone:828-208-2215
Mailing Address - Fax:
Practice Address - Street 1:1057 BROAD ST STE 48
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2565
Practice Address - Country:US
Practice Address - Phone:803-775-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2010152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist