Provider Demographics
NPI:1730172289
Name:MILFORD, JON MASSEY (OD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:MASSEY
Last Name:MILFORD
Suffix:
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 1:90 CHURCH ST
Mailing Address - Street 2:1115 SOUTH ELM STREET
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-1714
Mailing Address - Country:US
Mailing Address - Phone:706-335-5139
Mailing Address - Fax:706-335-9363
Practice Address - Street 1:1115 S ELM ST
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-2843
Practice Address - Country:US
Practice Address - Phone:706-335-5139
Practice Address - Fax:706-335-9363
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1016152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00278319BMedicaid
GA1174693410OtherMEDICARE GROUP NUMBER
GA1174693410OtherNPI GROUP NUMBER
GA00278319BMedicaid
GAT95696Medicare UPIN
GA1174693410OtherMEDICARE GROUP NUMBER