Individual provider Active NPI

Daniel Justin Miller, O.D.

  • Optometrist
  • Sumter, SC
National Provider Identifier
1205285780
Registry record updated Jan 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2010 Issued in SC
Practice address
1057 Broad St Ste 48
Sumter, SC 29150-2565
Phone
(803) 775-5050
NPI assigned
Jun 6, 2016
Last updated
Jan 24, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2010 SC Primary

Addresses

Primary practice location

1057 Broad St Ste 48
Sumter, SC 29150-2565

Mailing address

1000 Johnnie Dodds Blvd Ste 103-190
Mount Pleasant, SC 29464-3135
Phone (828) 208-2215

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180920000796 SC Practitioner - Optometry 3971891227

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2010SCMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
D.J. Miller O.D. and Associates, LLC Optometrist CurrentSince Jan 26, 2020 Accepting new patients

Locations

1000 Johnnie Dodds Blvd
Ste 103190
Mount Pleasant, SC 29464

1057 Broad St
Ste 48
Sumter, SC 29150
Phone (803) 775-5050

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1465171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579824000000",
    "number": "1205285780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 JOHNNIE DODDS BLVD STE 103-190",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294643135",
            "telephone_number": "828-208-2215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1057 BROAD ST STE 48",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291502565",
            "telephone_number": "803-775-5050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "DANIEL",
        "middle_name": "JUSTIN",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-06",
        "last_updated": "2020-01-24",
        "certification_date": "2020-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "2010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sumter, SC

Sources for this page

Verify at the official NPI Registry.