Provider Demographics
NPI:1457345837
Name:MILLER, J D (OD)
Entity Type:Individual
Prefix:
First Name:J D
Middle Name:
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 1:350 MOOSA BLVD
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-3626
Mailing Address - Country:US
Mailing Address - Phone:337-457-5277
Mailing Address - Fax:337-457-5277
Practice Address - Street 1:350 MOOSA BLVD
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-3626
Practice Address - Country:US
Practice Address - Phone:337-457-5277
Practice Address - Fax:337-457-5271
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA941084T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
47020DB38Medicare PIN
LA47020CY07Medicare PIN