Provider Demographics
NPI:1497597066
Name:MILETTA, SAMANTHA ALI (OD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ALI
Last Name:MILETTA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:205 LAUREL HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-3635
Mailing Address - Country:US
Mailing Address - Phone:856-455-5500
Mailing Address - Fax:856-455-5480
Practice Address - Street 1:211 BUCK ST
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-3817
Practice Address - Country:US
Practice Address - Phone:856-825-1011
Practice Address - Fax:856-327-1333
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00728600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist