Healthcare Provider Details

I. General information

NPI: 1720064371
Provider Name (Legal Business Name): STEVEN C MILLESON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S 6TH ST
IRONTON OH
45638-1623
US

IV. Provider business mailing address

220 S 6TH ST P.O. BOX 643
IRONTON OH
45638-1623
US

V. Phone/Fax

Practice location:
  • Phone: 740-532-2020
  • Fax: 740-532-0176
Mailing address:
  • Phone: 740-532-2020
  • Fax: 740-532-0176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3258/T724
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: