Provider Demographics
NPI:1306034517
Name:GLADYS C MILLS OD PA
Entity Type:Organization
Organization Name:GLADYS C MILLS OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:C
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-681-1125
Mailing Address - Street 1:6703 B NW LOOP 410
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238
Mailing Address - Country:US
Mailing Address - Phone:210-681-1125
Mailing Address - Fax:210-681-1148
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:78238-4504
Practice Address - Country:US
Practice Address - Phone:210-681-1125
Practice Address - Fax:210-681-1148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5260T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00438YMedicare PIN