Healthcare Provider Details

I. General information

NPI: 1235210584
Provider Name (Legal Business Name): MILAUSKAS EYE INSTITUTE MEDICAL GROUP II INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72057 DINAH SHORE DR SUITE D
RANCHO MIRAGE CA
92270-1791
US

IV. Provider business mailing address

PO BOX 845981
LOS ANGELES CA
90084-5981
US

V. Phone/Fax

Practice location:
  • Phone: 760-340-3937
  • Fax: 760-340-1940
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 TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

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