Provider Demographics
NPI:1538240973
Name:SCRUGGS, MILES DOUGLAS JR (OD)
Entity type:Individual
Prefix:DR
First Name:MILES
Middle Name:DOUGLAS
Last Name:SCRUGGS
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:792 SILVER BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-6055
Mailing Address - Country:US
Mailing Address - Phone:803-642-9902
Mailing Address - Fax:803-642-8611
Practice Address - Street 1:792 SILVER BLUFF RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-6055
Practice Address - Country:US
Practice Address - Phone:803-642-9902
Practice Address - Fax:803-642-8611
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC831152W00000X
LA964251T152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAT69525Medicare UPIN