Basic Information
| Provider Information | |||||||||
| NPI: | 1578753810 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLS | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | O.D., FAAO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 509 | ||||||||
| Address2: | |||||||||
| City: | HUMBOLDT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383430509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7317841186 | ||||||||
| FaxNumber: | 7317848228 | ||||||||
| Practice Location | |||||||||
| Address1: | 790 HIGHWAY 51 N STE 24 | ||||||||
| Address2: | |||||||||
| City: | RIPLEY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380636193 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316350991 | ||||||||
| FaxNumber: | 7316357372 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WL0500X | 777 | MS | N | Eye and Vision Services Providers | Optometrist | Low Vision Rehabilitation | 152WL0500X | R-171-TA-795 | AL | N | Eye and Vision Services Providers | Optometrist | Low Vision Rehabilitation | 152WL0500X | 5020 | MA | N | Eye and Vision Services Providers | Optometrist | Low Vision Rehabilitation | 152W00000X | 2764 | TN | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.