MEDICARE: DR. JOHN MICHAEL MILLS O.D.

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	1324	SC

General Provider Information

NPI Number	:	1730149964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MICHAEL MILLS O.D.

Provider Business Mailing Address
First Line	:	4343 CROSS CUT TRL
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-6904
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3013 NEWCASTLE LOOP
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-4502
Country	:	US
Telephone Number	:	843-215-3000
Fax Number	:	843-215-5310

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	06/12/2023

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