Provider Demographics
NPI:1194773820
Name:SALLY S. MILLER O.D. P.A.
Entity type:Organization
Organization Name:SALLY S. MILLER O.D. P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CPOT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SICKMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-288-1919
Mailing Address - Street 1:2616 LAWNDALE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-4800
Mailing Address - Country:US
Mailing Address - Phone:336-288-1919
Mailing Address - Fax:
Practice Address - Street 1:2616 LAWNDALE DR STE A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4801
Practice Address - Country:US
Practice Address - Phone:336-288-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC012W4OtherBLUE CROSS BLUE SHIELD
NC89012W4Medicaid
NC012W4OtherBLUE CROSS BLUE SHIELD
NC=========OtherPARTNERS
NC=========OtherCIGNA
NC=========OtherMEDCOST
NC=========OtherPARTNERS
NC0327310001Medicare NSC