Provider Demographics
NPI:1265568372
Name:MILLER, EDITH LEIGH (OD)
Entity type:Individual
Prefix:DR
First Name:EDITH
Middle Name:LEIGH
Last Name:MILLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PARK CIR
Mailing Address - Street 2:
Mailing Address - City:EGGERTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3227
Mailing Address - Country:US
Mailing Address - Phone:716-913-2089
Mailing Address - Fax:716-929-1545
Practice Address - Street 1:2101 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14207-1908
Practice Address - Country:US
Practice Address - Phone:716-874-2020
Practice Address - Fax:716-874-9504
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYV005422152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY141108Medicare ID - Type Unspecified
NY43711Medicare UPIN