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General NPI Number Information
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NPI Number | 1518203611
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Entity Type | Individual
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Provider Name | TRACY MULVEHILL MILLWOOD O.D.
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Gender | Female
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Dates
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Enumeration Date | 12/17/2012
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Last Update Date | 10/08/2019
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Provider Practice Location Address
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Address Line | 201 BANGOR AVE SE
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City | HANCEVILLE
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State | AL
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Zip | 35077-5645
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Country | US
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Telephone | 256-887-1550
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Fax |
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Provider Business Mailing Address
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Address Line | 160 GREEN ACRES BLVD
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City | TRAFFORD
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State | AL
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Zip | 35172-8782
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Country | US
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Telephone | 205-238-4466
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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 | S-C91-TA-938
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License Number State | AL
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