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General NPI Number Information
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NPI Number | 1184719296
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Entity Type | Individual
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Provider Name | BRIAN MACMILLAN O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 02/10/2022
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Provider Practice Location Address
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Address Line | 12100 SE STEVENS CT STE 106
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City | PORTLAND
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State | OR
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Zip | 97086-4707
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Country | US
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Telephone | 503-653-1442
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Fax |
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Provider Business Mailing Address
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Address Line | 12100 SE STEVENS CT STE 106
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City | PORTLAND
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State | OR
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Zip | 97086-4707
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OD 00001663
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1780ATI
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License Number State | OR
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