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General NPI Number Information
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NPI Number | 1962736876
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Entity Type | Organization
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Legal Business Name | MILAN OPTICAL INC.
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Dates
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Enumeration Date | 09/24/2009
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Last Update Date | 09/24/2009
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Provider Practice Location Address
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Address Line | 1929 EAST 10TH AVENUE
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City | MILAN
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State | IL
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Zip | 61264
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Country | US
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Telephone | 309-787-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 1929 EAST 10TH AVENUE
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City | MILAN
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State | IL
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Zip | 61264
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Country | US
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Telephone | 309-787-8100
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. RENEA HAINLINE
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Credential |
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Telephone | 309-787-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 3961-2384 IBT
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License Number State | IL
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