=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376927301
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MILLS EYE INSTITUTE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2015
-----------------------------------------------------
Last Update Date | 10/15/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 ASH ST
-----------------------------------------------------
City | SUSANVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96130-3714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-322-1000
-----------------------------------------------------
Fax | 775-322-1050
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10685 PROFESSIONAL CIR STE A
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89521-5843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-322-1000
-----------------------------------------------------
Fax | 775-322-1050
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MATTHEW B. MILLS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 775-322-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS0132X
-----------------------------------------------------
Taxonomy Name | Ophthalmologic Surgery Clinic/Center
-----------------------------------------------------
License Number | AO699360
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------