Healthcare Provider Details

I. General information

NPI: 1346216959
Provider Name (Legal Business Name): LESLIE BEARD MILLER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLIE GAYLE BEARD O.D.

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 HIGHLANDS DR SUITE 180
LITITZ PA
17543-2800
US

IV. Provider business mailing address

16 HORSESHOE DR
EPHRATA PA
17522-8811
US

V. Phone/Fax

Practice location:
  • Phone: 717-625-4600
  • Fax: 717-625-4676
Mailing address:
  • Phone: 717-733-7982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG0001151
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier467786
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA
# 2
Identifier1447707
Identifier TypeOTHER
Identifier State
Identifier IssuerHIGHMARK BLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: