Provider Demographics
NPI:1184814311
Name:MACMILLAN OPTICAL INC
Entity Type:Organization
Organization Name:MACMILLAN OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:MACMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:864-984-2020
Mailing Address - Street 1:106 S PUBLIC SQ
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-2923
Mailing Address - Country:US
Mailing Address - Phone:864-984-2020
Mailing Address - Fax:864-984-0336
Practice Address - Street 1:106 S PUBLIC SQ
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-2923
Practice Address - Country:US
Practice Address - Phone:864-984-2020
Practice Address - Fax:864-984-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0991305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD09916Medicaid