Provider Demographics
NPI:1033218003
Name:MILLS, GLADYS C (OD)
Entity Type:Individual
Prefix:DR
First Name:GLADYS
Middle Name:C
Last Name:MILLS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5202 SWAN GARDEN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78222
Mailing Address - Country:US
Mailing Address - Phone:210-333-8590
Mailing Address - Fax:
Practice Address - Street 1:6703-B NW LOOP 410
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238
Practice Address - Country:US
Practice Address - Phone:210-681-1125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5260T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D3378Medicare ID - Type Unspecified