Provider Demographics
NPI:1336107754
Name:MILLER, TIMOTHY CHRISTOPHER (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CHRISTOPHER
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 1:3720 SPARROW POND LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-8499
Mailing Address - Country:US
Mailing Address - Phone:919-782-9091
Mailing Address - Fax:
Practice Address - Street 1:4151 MAIN AT NORTH HILLS ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5784
Practice Address - Country:US
Practice Address - Phone:919-782-9091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1585152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909592Medicaid
NC2470151Medicare PIN
NC8909592Medicaid