Basic Information
| Provider Information | |||||||||
| NPI: | 1689799603 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DRS. MILBURN - WOOSTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1713 PRESTON RD STE A | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750935155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304164569 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1713 PRESTON RD | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750935283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729315775 | ||||||||
| FaxNumber: | 3303458041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 09/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MILBURN | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3304164569 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 5133 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.