Provider Demographics
NPI:1942395728
Name:MCMILLIN, KAREN LOUISE (OD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LOUISE
Last Name:MCMILLIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:LOUISE
Other - Last Name:HOLEWINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:340 MEIJER WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3340
Mailing Address - Country:US
Mailing Address - Phone:859-278-2020
Mailing Address - Fax:859-277-4490
Practice Address - Street 1:340 MEIJER WAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3340
Practice Address - Country:US
Practice Address - Phone:859-278-2020
Practice Address - Fax:859-277-4490
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1202DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77012029Medicaid
KY77012029Medicaid
KY0914406Medicare PIN