Healthcare Provider Details

I. General information

NPI: 1669505939
Provider Name (Legal Business Name): MILLS OPTOMETRIC ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 E ELK AVE
ELIZABETHTON TN
37643-3221
US

IV. Provider business mailing address

321 E ELK AVE
ELIZABETHTON TN
37643-3221
US

V. Phone/Fax

Practice location:
  • Phone: 423-542-2512
  • Fax: 423-542-0477
Mailing address:
  • Phone: 423-542-2512
  • Fax: 423-542-0477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number0710
License Number StateTN

VIII. Authorized Official

Name: SHERI KRESS
Title or Position: OFFICE MANAGER
Credential:
Phone: 423-542-2512