Basic Information
| Provider Information | |||||||||
| NPI: | 1316116437 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MILAUSKAS EYE INSTITUTE MEDICAL GROUP II INC | ||||||||
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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: | 41990 COOK ST STE 502 | ||||||||
| Address2: | |||||||||
| City: | PALM DESERT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922116102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608343382 | ||||||||
| FaxNumber: | 7603274313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2008 | ||||||||
| LastUpdateDate: | 02/05/2020 | ||||||||
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| AuthorizedOfficialLastName: | NEAL | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSISTANT SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 8443776468 | ||||||||
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| 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 | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 3891320 | 05 | CA | MEDICAID |