Provider Demographics
NPI:1154323632
Name:MILLER, JEFF D (OD)
Entity type:Individual
Prefix:DR
First Name:JEFF
Middle Name:D
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 1:1711 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4200
Mailing Address - Country:US
Mailing Address - Phone:405-372-1715
Mailing Address - Fax:405-372-3350
Practice Address - Street 1:1711 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4200
Practice Address - Country:US
Practice Address - Phone:405-372-1715
Practice Address - Fax:405-372-3350
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1182152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU11724Medicare UPIN