Provider Demographics
NPI:1285618264
Name:MILLER, SALLY S (OD)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:S
Last Name:MILLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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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:336-545-1931
Practice Address - Street 1:2616 LAWNDALE DR
Practice Address - Street 2:SUITE A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4800
Practice Address - Country:US
Practice Address - Phone:336-288-1919
Practice Address - Fax:336-545-1931
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2010-07-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC1024152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC21942OtherPARTNERS
NC2200500OtherUNITED HEALTH CARE
NC0327310001OtherDMERC SUPPLIER NUMBER
NC410047496OtherRAILROAD
NC8909646Medicaid
NC7854033OtherCIGNA
NC09646OtherBCBS OF NC
NC66442OtherMEDCOST
NC09646OtherBCBS OF NC
NC2200500OtherUNITED HEALTH CARE