Organization Active NPI

Don Edward Mills Jr OD PA

  • Optometrist
  • Mooresville, NC
National Provider Identifier
1447379490
Registry record updated Aug 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
DON EDWARD MILLS JR OD PA
Practice address
492 Williamson Rd
Mooresville, NC 28117-9185
Phone
(704) 664-9121
Fax
(704) 664-4886
NPI assigned
Mar 29, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2010

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

Authorized official

Name
Ms. Donna W Bennett
Title
Office Manager
Phone
(704) 664-9121

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

492 Williamson Rd
Mooresville, NC 28117-9185

Mailing address

492 Williamson Rd
Mooresville, NC 28117-9185
Phone (704) 664-9121

Other identifiers 2

IdentifierTypeStateIssuer
DQ3416OtherNCRAILROAD MEDICARE
019MMOtherNCBLUE CROSS BLUE SHIELD

Other names 1

  • Eye Care Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091215000205 NC Part B Supplier - Clinic/Group Practice 9234279787 Receives reassigned benefits from 2 practitioners
Practice locations: Mooresville, NC

National Provider Directory

National Provider Directory

Locations

492 Williamson Rd
Mooresville, NC 28117
Phone (704) 264-7593

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280793600000",
    "number": "1447379490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "492 WILLIAMSON RD",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281179185",
            "telephone_number": "704-664-9121",
            "fax_number": "704-664-4886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "492 WILLIAMSON RD",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281179185",
            "telephone_number": "704-664-9121",
            "fax_number": "704-664-4886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DON EDWARD MILLS JR OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2010-08-03",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "704-664-9121",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DQ3416",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "019MM",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eye Care Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mooresville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.