Provider Demographics
NPI:1427288372
Name:MCMILLIN, WILLIAM PAUL (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PAUL
Last Name:MCMILLIN
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 1:4617 FORT HENRY DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2616
Mailing Address - Country:US
Mailing Address - Phone:423-239-5491
Mailing Address - Fax:423-239-4860
Practice Address - Street 1:4617 FORT HENRY DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-2616
Practice Address - Country:US
Practice Address - Phone:423-239-5491
Practice Address - Fax:423-239-4860
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2893152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1031415901Medicare PIN