Healthcare Provider Details

I. General information

NPI: 1528258753
Provider Name (Legal Business Name): MACMILLAN OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MAIN ST STE 7
SPARTANBURG SC
29307-1738
US

IV. Provider business mailing address

1200 E MAIN ST STE 7
SPARTANBURG SC
29307-1738
US

V. Phone/Fax

Practice location:
  • Phone: 864-585-7807
  • Fax: 864-585-8272
Mailing address:
  • Phone: 864-585-7807
  • Fax: 864-585-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number0991
License Number StateSC

VIII. Authorized Official

Name: THOMAS F MACMILLAN
Title or Position: OWNER
Credential: OD
Phone: 864-585-7807