Healthcare Provider Details

I. General information

NPI: 1740349943
Provider Name (Legal Business Name): MILAUSKAS EYE INSTITUTE MEDICAL GROUP II INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E TACHEVAH DR SUITE 101E
PALM SPRINGS CA
92262-5750
US

IV. Provider business mailing address

PO BOX 845981
LOS ANGELES CA
90084-5981
US

V. Phone/Fax

Practice location:
  • Phone: 760-327-1561
  • Fax: 760-327-4313
Mailing address:
  • Phone: 760-340-3937
  • Fax: 760-340-1940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. GEORGE NEAL
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 844-377-6468