Basic Information
| Provider Information | |||||||||
| NPI: | 1235210584 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MILAUSKAS EYE INSTITUTE MEDICAL GROUP II INC | ||||||||
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| OtherOrganizationName: | MILAUSKAS EYE INSTITUTE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 845981 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900845981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603403937 | ||||||||
| FaxNumber: | 7603401940 | ||||||||
| Practice Location | |||||||||
| Address1: | 72057 DINAH SHORE DR | ||||||||
| Address2: | SUITE D | ||||||||
| City: | RANCHO MIRAGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922701791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603403937 | ||||||||
| FaxNumber: | 7603401940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 02/05/2020 | ||||||||
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| AuthorizedOfficialLastName: | NEAL | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSISTANT SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 8443776468 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 02/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | N | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 207W00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 3891320 | 05 | CA | MEDICAID |