Provider Demographics
NPI:1194701110
Name:MCMILLIAN, JEFF A (OD)
Entity type:Individual
Prefix:MR
First Name:JEFF
Middle Name:A
Last Name:MCMILLIAN
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:PO BOX 383
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:TN
Mailing Address - Zip Code:38004-0383
Mailing Address - Country:US
Mailing Address - Phone:901-840-3937
Mailing Address - Fax:901-840-3395
Practice Address - Street 1:185 WESLEY REED DR
Practice Address - Street 2:STE. E
Practice Address - City:ATOKA
Practice Address - State:TN
Practice Address - Zip Code:38004-4955
Practice Address - Country:US
Practice Address - Phone:901-840-3937
Practice Address - Fax:901-840-3395
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT1601152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3941960Medicaid
TN3941962Medicare ID - Type UnspecifiedPROVIDER NUMBER
TN3941960Medicaid