Provider Demographics
NPI:1720724834
Name:MILLIKIN, CADE
Entity Type:Individual
Prefix:
First Name:CADE
Middle Name:
Last Name:MILLIKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:HEDRICK
Mailing Address - State:IA
Mailing Address - Zip Code:52563-9313
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:122 N COURT ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-2815
Practice Address - Country:US
Practice Address - Phone:641-472-6694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA114535152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist