Provider Demographics
NPI:1982786216
Name:MILLER, THOMAS R JR (OD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:R
Last Name:MILLER
Suffix:JR
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 1:11724 RETAIL DR.
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587
Mailing Address - Country:US
Mailing Address - Phone:919-562-5559
Mailing Address - Fax:919-562-5563
Practice Address - Street 1:11724 RETAIL DR.
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587
Practice Address - Country:US
Practice Address - Phone:919-562-5559
Practice Address - Fax:919-562-5563
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1802152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0929YOtherNC HEALTHCHOICE
NC0929YOtherBLUE CROSS BLUE SHIELD
NC890929YMedicaid
NC2238815OtherUNITED HEALTH CARE
NC0929YOtherNC HEALTHCHOICE
NCU81849Medicare UPIN