MEDICARE: CAITLIN MILLSAPS OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3848	TN

General Provider Information

NPI Number	:	1518731918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLIN MILLSAPS OD

Provider Business Mailing Address
First Line	:	126 E BOCKMAN WAY
Second Line	:
City	:	SPARTA
State	:	TN
Zip	:	38583-2036
Country	:	US
Telephone Number	:	931-836-2235
Fax Number	:

Provider Business Practice Location Address
First Line	:	126 E BOCKMAN WAY
Second Line	:
City	:	SPARTA
State	:	TN
Zip	:	38583-2036
Country	:	US
Telephone Number	:	931-836-2235
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2023
Last Update Date	:	11/07/2023

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