MEDICARE: DR. HENRY B MILLER OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	605	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	T24017	OTHER	SC	NSC
3	0239370001	OTHER	SC	DME

General Provider Information

NPI Number	:	1386695294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY B MILLER OD

Provider Business Mailing Address
First Line	:	2757 LAUREL ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2037
Country	:	US
Telephone Number	:	803-799-7358
Fax Number	:

Provider Business Practice Location Address
First Line	:	2757 LAUREL ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2037
Country	:	US
Telephone Number	:	803-799-7358
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	05/06/2008

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