Provider Demographics
NPI:1972819365
Name:MICAH S MILLS OD PA
Entity Type:Organization
Organization Name:MICAH S MILLS OD PA
Other - Org Name:TREASURE VALLEY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-459-2641
Mailing Address - Street 1:1702 S KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4826
Mailing Address - Country:US
Mailing Address - Phone:208-459-2641
Mailing Address - Fax:208-459-2895
Practice Address - Street 1:1702 S KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4826
Practice Address - Country:US
Practice Address - Phone:208-459-2641
Practice Address - Fax:208-459-2895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDDQ8178OtherRAILROAD MEDICARE
ID1972819365Medicaid
ID15900302Medicare PIN
IDDQ8178OtherRAILROAD MEDICARE