Provider Demographics
NPI:1184614083
Name:MILLS, DAVID H (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:MILLS
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 1:321 E ELK AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-3221
Mailing Address - Country:US
Mailing Address - Phone:423-542-2512
Mailing Address - Fax:423-542-0477
Practice Address - Street 1:321 E ELK AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-3221
Practice Address - Country:US
Practice Address - Phone:423-542-2512
Practice Address - Fax:423-542-0477
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0710152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3945609Medicaid
1669505939OtherWPS TRICARE
TNP00914229OtherMEDICARE RAILROAD
TN0124024OtherBLUECROSSBLUESHIELD OF TN
NC7909631Medicaid
TN0124024OtherBLUECROSSBLUESHIELD OF TN
TNT61184Medicare UPIN
TN6451700001Medicare NSC