Provider Demographics
NPI:1912932112
Name:MILLS, VANESSA M (OD)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:M
Last Name:MILLS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 SPRINGBANK LANE
Mailing Address - Street 2:STE 200
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3362
Mailing Address - Country:US
Mailing Address - Phone:704-540-9595
Mailing Address - Fax:704-540-3362
Practice Address - Street 1:3025 SPRINGBANK LANE
Practice Address - Street 2:STE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3362
Practice Address - Country:US
Practice Address - Phone:704-540-9595
Practice Address - Fax:704-540-9616
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC1958152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC247411Medicaid
NC247411Medicaid