Provider Demographics
NPI:1366445900
Name:MILLS, RICHARD ELLIOTT (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ELLIOTT
Last Name:MILLS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 S HARVARD AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2611
Mailing Address - Country:US
Mailing Address - Phone:918-747-2020
Mailing Address - Fax:918-747-2056
Practice Address - Street 1:4444 S HARVARD AVE
Practice Address - Street 2:STE 300
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2611
Practice Address - Country:US
Practice Address - Phone:918-747-2020
Practice Address - Fax:918-747-2056
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1471207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0519543OtherUNITED HEALTHCARE
OK731508848-004OtherBCBS OF OKLAHOMA
OK4363309OtherAETNA
OK0519543OtherUNITED HEALTHCARE
OK4363309OtherAETNA