Healthcare Provider Details

I. General information

NPI: 1518203611
Provider Name (Legal Business Name): TRACY MULVEHILL MILLWOOD O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BANGOR AVE SE
HANCEVILLE AL
35077-5645
US

IV. Provider business mailing address

160 GREEN ACRES BLVD
TRAFFORD AL
35172-8782
US

V. Phone/Fax

Practice location:
  • Phone: 256-887-1550
  • Fax:
Mailing address:
  • Phone: 205-238-4466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-C91-TA-938
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: