Healthcare Provider Details

I. General information

NPI: 1205889466
Provider Name (Legal Business Name): JEFFREY T MILLER OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43560 VAN DYKE AVE
STERLING HEIGHTS MI
48314-2436
US

IV. Provider business mailing address

43560 VAN DYKE AVE
STERLING HEIGHTS MI
48314-2436
US

V. Phone/Fax

Practice location:
  • Phone: 586-254-9600
  • Fax: 586-254-6787
Mailing address:
  • Phone: 586-254-9600
  • Fax: 586-254-6787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: