Provider Demographics
NPI:1447379490
Name:DON EDWARD MILLS JR OD PA
Entity type:Organization
Organization Name:DON EDWARD MILLS JR OD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:W
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-664-9121
Mailing Address - Street 1:492 WILLIAMSON RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9185
Mailing Address - Country:US
Mailing Address - Phone:704-664-9121
Mailing Address - Fax:704-664-4886
Practice Address - Street 1:492 WILLIAMSON RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9185
Practice Address - Country:US
Practice Address - Phone:704-664-9121
Practice Address - Fax:704-664-4886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCDQ3416OtherRAILROAD MEDICARE
NC019MMOtherBLUE CROSS BLUE SHIELD
NC0661770001Medicare NSC
NC246625Medicare PIN