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General NPI Number Information
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NPI Number | 1003245036
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Entity Type | Organization
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Legal Business Name | LINDY MCMILLIN O.D., LLC
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Dates
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Enumeration Date | 11/12/2013
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Last Update Date | 11/12/2013
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Provider Practice Location Address
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Address Line | 1088 W BROADWAY ST
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City | MONTICELLO
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State | IN
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Zip | 47960-1816
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Country | US
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Telephone | 574-583-4108
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Fax |
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Provider Business Mailing Address
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Address Line | 9626 S 550 W
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City | LAFAYETTE
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State | IN
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Zip | 47909-9284
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Country | US
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Telephone | 765-490-6309
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | LINDY J MCMILLIN
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Credential | O.D.
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Telephone | 765-490-6309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18003603A
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License Number State | IN
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