Provider Demographics
NPI:1578753810
Name:MILLS, NICOLE M (OD, FAAO)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:MILLS
Suffix:
Gender:F
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:TN
Mailing Address - Zip Code:38343-0509
Mailing Address - Country:US
Mailing Address - Phone:731-784-1186
Mailing Address - Fax:731-784-8228
Practice Address - Street 1:790 HIGHWAY 51 N STE 24
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:TN
Practice Address - Zip Code:38063-6193
Practice Address - Country:US
Practice Address - Phone:731-635-0991
Practice Address - Fax:731-635-7372
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS777152WL0500X
ALR-171-TA-795152WL0500X
MA5020152WL0500X
TN2764152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation