MEDICARE: DR. BEVERLY MILLER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	27OA00293200	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	261569654	OTHER	NJ	QUALCARE
2	510341	OTHER	NJ	AETNA
3	261569654	OTHER	NJ	VSP
4	261569654	OTHER	NJ	HORIZON BLUE CROSS/SHIELD
5	261569654	OTHER	NJ	BEECH STREET
6	261569654	OTHER	NJ	UNITED HEALTHCARE
7	261569654	OTHER	NJ	CIGNA

General Provider Information

NPI Number	:	1043215940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEVERLY MILLER O.D.

Provider Business Mailing Address
First Line	:	10 CODINGTON PL
Second Line	:
City	:	SOMERVILLE
State	:	NJ
Zip	:	08876-2408
Country	:	US
Telephone Number	:	908-725-0144
Fax Number	:	908-722-6785

Provider Business Practice Location Address
First Line	:	10 CODINGTON PL
Second Line	:
City	:	SOMERVILLE
State	:	NJ
Zip	:	08876-2408
Country	:	US
Telephone Number	:	908-725-0144
Fax Number	:	908-722-6785

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	04/22/2008

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Directions to “ DR. BEVERLY MILLER O.D.” Practice Location

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