Healthcare Provider Details

I. General information

NPI: 1396477402
Provider Name (Legal Business Name): KATHLEEN C MILLER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7560 CARPENTER FIRE STATION RD STE 205
CARY NC
27519-9637
US

IV. Provider business mailing address

329 BUCKLAND MILLS CT
CARY NC
27513-4284
US

V. Phone/Fax

Practice location:
  • Phone: 919-465-7400
  • Fax: 919-465-7455
Mailing address:
  • Phone: 214-799-4724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2865
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT003425
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: