Individual
DR. MICHAEL E. MILLSAP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
515 E 1ST ST, SALIDA, CO 81201-2805
(719) 539-3581
(719) 539-4992
Mailing address
27 MONTEBELLO RD, PUEBLO, CO 81001-1236
(719) 545-1530
(719) 545-2899
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1365
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08013658
—
CO
01
—
COA104412
MEDICARE
CO
Enumeration date
09/29/2008
Last updated
01/20/2016
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