Healthcare Provider Details

I. General information

NPI: 1407843782
Provider Name (Legal Business Name): MATTHEW BRONSON MILLS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10685 PROFESSIONAL CIR SUITE A
RENO NV
89521-5856
US

IV. Provider business mailing address

10685 PROFESSIONAL CIR SUITE A
RENO NV
89521-5856
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 Code207W00000X
TaxonomyOphthalmology Physician
License Number9064
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: