Provider Demographics
NPI:1477584605
Name:MILLSAP, CHAD THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:THOMAS
Last Name:MILLSAP
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 1:2170 N LINCOLN AVE
Mailing Address - Street 2:#1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4511
Mailing Address - Country:US
Mailing Address - Phone:773-327-8519
Mailing Address - Fax:773-327-3015
Practice Address - Street 1:1515 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2009
Practice Address - Country:US
Practice Address - Phone:773-772-2424
Practice Address - Fax:773-772-2828
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.009390152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL92888Medicare UPIN
ILK18594Medicare PIN