Provider Demographics
NPI:1659566735
Name:MILLARS ORTHOTIC & PROSTHETIC, INC
Entity Type:Organization
Organization Name:MILLARS ORTHOTIC & PROSTHETIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:MILLAR
Authorized Official - Suffix:
Authorized Official - Credentials:ABC
Authorized Official - Phone:940-322-4647
Mailing Address - Street 1:905 HOLLIDAY ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4312
Mailing Address - Country:US
Mailing Address - Phone:940-322-4647
Mailing Address - Fax:940-322-9806
Practice Address - Street 1:905 HOLLIDAY ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4312
Practice Address - Country:US
Practice Address - Phone:940-322-4647
Practice Address - Fax:940-322-9806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0349550001Medicare NSC