Healthcare Provider Details

I. General information

NPI: 1376927301
Provider Name (Legal Business Name): MILLS EYE INSTITUTE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 ASH ST
SUSANVILLE CA
96130-3714
US

IV. Provider business mailing address

10685 PROFESSIONAL CIR STE A
RENO NV
89521-5843
US

V. Phone/Fax

Practice location:
  • Phone: 775-322-1000
  • Fax: 775-322-1050
Mailing address:
  • Phone: 775-322-1000
  • Fax: 775-322-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License NumberAO699360
License Number StateCA

VIII. Authorized Official

Name: MATTHEW B. MILLS
Title or Position: OWNER
Credential: M.D.
Phone: 775-322-1000