Provider Demographics
NPI:1750378204
Name:MILLER, JAMES ANDREW (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ANDREW
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 1:801 VOLVO PKWY
Mailing Address - Street 2:SUITE 133
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2811
Mailing Address - Country:US
Mailing Address - Phone:757-549-2225
Mailing Address - Fax:757-549-0380
Practice Address - Street 1:801 VOLVO PKWY
Practice Address - Street 2:SUITE 133
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2811
Practice Address - Country:US
Practice Address - Phone:757-549-2225
Practice Address - Fax:757-549-0380
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001590152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA09081T00OtherMEDICARE INDIVIDUAL PTAN
VAP01030183Medicare PIN
VA09081T00OtherMEDICARE INDIVIDUAL PTAN