Individual provider Active NPI

William Paul McMillin, O.D.

  • Optometrist
  • Kingsport, TN
National Provider Identifier
1427288372
Registry record updated May 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2893 Issued in TN
Practice address
4617 Fort Henry Dr
Kingsport, TN 37663-2616
Phone
(423) 239-5491
Fax
(423) 239-4860
NPI assigned
Jul 24, 2009
Last updated
May 4, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 4, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2893 TN Primary

Addresses

Primary practice location

4617 Fort Henry Dr
Kingsport, TN 37663-2616

Mailing address

4617 Fort Henry Dr
Kingsport, TN 37663-2616
Phone (423) 239-5491

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100326000771 TN Practitioner - Optometry 7416083621 Reassigns benefits to 1 organization
Practice locations: Kingport, TN

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University Alabama Birmingham - School of Optometry, 2009
Medicare assignment
May accept Medicare assignment
Group practices
Mac2 PLLCGroup PAC ID 9537424387, 4 clinicians

Practice addresses (Care Compare)

4617 Fort Henry Dr
Kingsport, TN 37663-2616
Phone (423) 239-5491

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery34

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2893TNMDClinical Neuropsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Mac2, PLLC CurrentSince Jan 1, 2018 Accepting new patients

Locations

4617 Fort Henry Dr
Kingsport, TN 37663
Phone (423) 239-5491

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1248393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272931200000",
    "number": "1427288372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4617 FORT HENRY DR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376632616",
            "telephone_number": "423-239-5491",
            "fax_number": "423-239-4860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4617 FORT HENRY DR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376632616",
            "telephone_number": "423-239-5491",
            "fax_number": "423-239-4860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCMILLIN",
        "first_name": "WILLIAM",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-07-24",
        "last_updated": "2010-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "2893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsport, TN

Sources for this page

Verify at the official NPI Registry.