Provider Demographics
NPI:1568417640
Name:MILLAS, THEMISTOCLES DEMETRIOS (OD)
Entity Type:Individual
Prefix:DR
First Name:THEMISTOCLES
Middle Name:DEMETRIOS
Last Name:MILLAS
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 1:519 BORDEN AVE
Mailing Address - Street 2:APT 3G
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5876
Mailing Address - Country:US
Mailing Address - Phone:917-881-1128
Mailing Address - Fax:
Practice Address - Street 1:3018 31ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-2270
Practice Address - Country:US
Practice Address - Phone:718-254-5575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006983-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC438B1Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NYV08201Medicare UPIN