Provider Demographics
NPI:1164594230
Name:MILANO EYECARE
Entity Type:Organization
Organization Name:MILANO EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:G
Authorized Official - Last Name:MILANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-832-2252
Mailing Address - Street 1:125 CENTRAL AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-1847
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 CENTRAL AVE
Practice Address - Street 2:SUITE D
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-1847
Practice Address - Country:US
Practice Address - Phone:256-832-2252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS904TA468152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009971095Medicaid
AL51524860OtherBLUE CROSS BLUE SHIELD
AL5482660001Medicare NSC
ALU80797Medicare UPIN
AL009971095Medicaid