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General NPI Number Information
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NPI Number | 1528258753
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Entity Type | Organization
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Legal Business Name | MACMILLAN OPTICAL INC
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 07/25/2007
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Provider Practice Location Address
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Address Line | 1200 E MAIN ST STE 7
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City | SPARTANBURG
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State | SC
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Zip | 29307-1738
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Country | US
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Telephone | 864-585-7807
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Fax | 864-585-8272
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Provider Business Mailing Address
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Address Line | 1200 E MAIN ST STE 7
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City | SPARTANBURG
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State | SC
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Zip | 29307-1738
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Country | US
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Telephone | 864-585-7807
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Fax | 864-585-8272
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS F MACMILLAN
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Credential | OD
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Telephone | 864-585-7807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 0991
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License Number State | SC
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