Healthcare Provider Details

I. General information

NPI: 1235178989
Provider Name (Legal Business Name): ROBERT COLEMAN MILLS JR. OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 S MCCASKEY RD
WILLIAMSTON NC
27892-2150
US

IV. Provider business mailing address

316 S MCCASKEY RD
WILLIAMSTON NC
27892-2150
US

V. Phone/Fax

Practice location:
  • Phone: 252-792-2250
  • Fax: 252-792-6293
Mailing address:
  • Phone: 252-792-2250
  • Fax: 252-792-6293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1337
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: