Healthcare Provider Details

I. General information

NPI: 1154305910
Provider Name (Legal Business Name): THOMAS F MACMILLAN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22995 US HIGHWAY 76
CLINTON SC
29325-7529
US

IV. Provider business mailing address

PO BOX 896189
CHARLOTTE NC
28289-6189
US

V. Phone/Fax

Practice location:
  • Phone: 864-654-6706
  • Fax:
Mailing address:
  • Phone: 864-654-6706
  • Fax: 864-833-5520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberSC0991
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: