Healthcare Provider Details

I. General information

NPI: 1063475168
Provider Name (Legal Business Name): TERRY W. MILLER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 HARRISON RD
THOMSON GA
30824
US

IV. Provider business mailing address

2205 HARRISON RD
THOMSON GA
30824
US

V. Phone/Fax

Practice location:
  • Phone: 706-595-9522
  • Fax: 706-595-6512
Mailing address:
  • Phone: 706-595-9533
  • Fax: 706-595-6512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT001399
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: