Healthcare Provider Details

I. General information

NPI: 1194773820
Provider Name (Legal Business Name): SALLY S. MILLER O.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 LAWNDALE DR STE A
GREENSBORO NC
27408-4801
US

IV. Provider business mailing address

2616 LAWNDALE DR SUITE A
GREENSBORO NC
27408-4800
US

V. Phone/Fax

Practice location:
  • Phone: 336-288-1919
  • Fax:
Mailing address:
  • Phone: 336-288-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNC

VIII. Authorized Official

Name: MRS. DONNA SICKMILLER
Title or Position: CPOT
Credential:
Phone: 336-288-1919