Provider Demographics
NPI:1144240706
Name:MILLIKAN, DAVID JOHN (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:MILLIKAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9795 CROSSPOINT BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3354
Mailing Address - Country:US
Mailing Address - Phone:317-254-6480
Mailing Address - Fax:317-259-8609
Practice Address - Street 1:1921 E 53RD ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-3164
Practice Address - Country:US
Practice Address - Phone:765-649-2278
Practice Address - Fax:765-622-7171
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002831A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200151240Medicaid
IN144630Medicare ID - Type Unspecified
IN200151240Medicaid