Basic Information
| Provider Information | |||||||||
| NPI: | 1124114830 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | SHEILA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 32 HIGHLAND DR | ||||||||
| Address2: | |||||||||
| City: | FLEETWOOD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 195229617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105686981 | ||||||||
| FaxNumber: | 6106825022 | ||||||||
| Practice Location | |||||||||
| Address1: | 2910 N 5TH ST | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196052461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109292531 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 05/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OEG001646 | PA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 02709400 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 459968 | 01 | PA | AETNA | OTHER |