Provider Demographics
NPI:1669585212
Name:MILL, FREDERICK (OD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:
Last Name:MILL
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 1:82 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-1450
Mailing Address - Country:US
Mailing Address - Phone:781-585-2332
Mailing Address - Fax:781-585-6257
Practice Address - Street 1:82 SUMMER ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-1450
Practice Address - Country:US
Practice Address - Phone:781-585-2332
Practice Address - Fax:781-585-6257
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2445-TP152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0325163Medicaid