Provider Demographics
NPI:1548541972
Name:MACMILLAN, HUGH ALLAN III (OD)
Entity type:Individual
Prefix:
First Name:HUGH
Middle Name:ALLAN
Last Name:MACMILLAN
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3865 CHERRY CREEK DRIVE NORTH
Mailing Address - Street 2:C/O STACK OPTICAL
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209
Mailing Address - Country:US
Mailing Address - Phone:303-321-1578
Mailing Address - Fax:303-322-3431
Practice Address - Street 1:3865 CHERRY CREEK DRIVE NORTH
Practice Address - Street 2:C/O STACK OPTICAL
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209
Practice Address - Country:US
Practice Address - Phone:303-321-1578
Practice Address - Fax:303-322-3431
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO#997152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist