Provider Demographics
NPI:1386762094
Name:MCILWAIN, FRANK (OD)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:MCILWAIN
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 236
Mailing Address - Street 2:
Mailing Address - City:WASKOM
Mailing Address - State:TX
Mailing Address - Zip Code:75692-0236
Mailing Address - Country:US
Mailing Address - Phone:903-687-3680
Mailing Address - Fax:
Practice Address - Street 1:620 INTERSTATE 20 SERVICE ROAD
Practice Address - Street 2:
Practice Address - City:WASKOM
Practice Address - State:TX
Practice Address - Zip Code:75692-0236
Practice Address - Country:US
Practice Address - Phone:903-687-3680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2737T152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision