Provider Demographics
NPI:1124114830
Name:MILLER, SHEILA R (OD)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:R
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 1:32 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522-9617
Mailing Address - Country:US
Mailing Address - Phone:610-568-6981
Mailing Address - Fax:610-682-5022
Practice Address - Street 1:2910 N 5TH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-2461
Practice Address - Country:US
Practice Address - Phone:610-929-2531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001646152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02709400OtherCAPITAL BLUE CROSS
PA459968OtherAETNA
PA02709400OtherCAPITAL BLUE CROSS
PA459968OtherAETNA
PAF39963Medicare UPIN