NPIMap

Organization Active NPI

Mac2, PLLC

  • Durable Medical Equipment & Medical Supplies
  • Kingsport, TN
National Provider Identifier
1457522237
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
621039107 Issued in TN
Legal business name
MAC2, PLLC
Doing business as
McMillin Eyecare
Practice address
4617 Fort Henry Dr
Kingsport, TN 37663-2616
Phone
(423) 239-5491
Fax
(423) 239-4860
NPI assigned
Mar 19, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Dr. William C McMillin, O.D.NPI 1861414088
Title
Optometrist
Phone
(423) 239-5491

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 621039107 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

Other identifiers 1

IdentifierTypeStateIssuer
0258190001OtherTNDMERC

Other names 2

  • McMillin Eyecare Doing business as
  • William C. McMillin, OD Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180525000344 TN Part B Supplier - Clinic/Group Practice 9537424387 Receives reassigned benefits from 4 practitioners
Practice locations: Kingsport, TN

National Provider Directory

National Provider Directory

Locations

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

Practitioners & affiliated clinicians

Practitioners 4

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": "1205884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1457522237",
    "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": {
        "organization_name": "MAC2, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-19",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "MCMILLIN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "423-239-5491",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TN",
            "license": "621039107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "0258190001",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McMillin Eyecare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "William C. McMillin, OD",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Kingsport, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.