Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 207T | WY |
NPI | 1003837881 |
---|---|
Provider Name | Dr. Jill Miller |
First Address | Sheridan, WY 82801-4224 |
Second Address | Sheridan, WY 82801-4224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 09/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
116983100 | (05) | WY |
U35727 | (02) | WY |