Provider Demographics
NPI:1154305910
Name:MACMILLAN, THOMAS F (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:F
Last Name:MACMILLAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MUSGROVE ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-2350
Mailing Address - Country:US
Mailing Address - Phone:864-833-5555
Mailing Address - Fax:864-833-5520
Practice Address - Street 1:118 MUSGROVE ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-2350
Practice Address - Country:US
Practice Address - Phone:864-833-5555
Practice Address - Fax:864-833-5520
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC0991152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD09916Medicaid
SC5595510001Medicare NSC
SCD09916Medicaid
SCU43598Medicare UPIN
SC8525Medicare PIN
SC7266Medicare PIN
SC0634030001Medicare NSC
SCU435988525Medicare PIN