Provider Demographics
NPI:1457522237
Name:MAC2, PLLC
Entity Type:Organization
Organization Name:MAC2, PLLC
Other - Org Name:WILLIAM C. MCMILLIN, OD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCMILLIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-239-5491
Mailing Address - Street 1:4617 FORT HENRY DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2616
Mailing Address - Country:US
Mailing Address - Phone:423-239-5491
Mailing Address - Fax:423-239-4860
Practice Address - Street 1:4617 FORT HENRY DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-2616
Practice Address - Country:US
Practice Address - Phone:423-239-5491
Practice Address - Fax:423-239-4860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN621039107332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0258190001OtherDMERC
TN0258190001OtherDMERC
TN3594131Medicare PIN