Healthcare Provider Details

I. General information

NPI: 1184730251
Provider Name (Legal Business Name): MILLENNIUM VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18325 N ALLIED WAY SUITE 100
PHOENIX AZ
85054-3106
US

IV. Provider business mailing address

18325 N ALLIED WAY STE 100
PHOENIX AZ
85054-3106
US

V. Phone/Fax

Practice location:
  • Phone: 602-467-4966
  • Fax: 480-419-5401
Mailing address:
  • Phone: 602-467-4966
  • Fax: 480-419-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0794671-4
License Number StateAZ

VIII. Authorized Official

Name: JEFF HAAKE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 480-419-5413