Provider Demographics
NPI:1811957319
Name:MILLER, JILL PAXTON (OD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:PAXTON
Last Name:MILLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 JONESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-6214
Mailing Address - Country:US
Mailing Address - Phone:717-540-4070
Mailing Address - Fax:717-545-6441
Practice Address - Street 1:4600 JONESTOWN RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-6214
Practice Address - Country:US
Practice Address - Phone:717-540-4070
Practice Address - Fax:717-545-6441
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000939152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU43557Medicare UPIN