Provider Demographics
NPI:1326158478
Name:HOM, MILTON (OD, FAAO)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:
Last Name:HOM
Suffix:
Gender:M
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 E ALOSTA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-2706
Mailing Address - Country:US
Mailing Address - Phone:626-334-1585
Mailing Address - Fax:626-335-1402
Practice Address - Street 1:822 E ALOSTA AVE STE A
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-2706
Practice Address - Country:US
Practice Address - Phone:626-334-1585
Practice Address - Fax:626-335-1402
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7221T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0072210Medicaid
CASD0072210Medicaid
CAT70182Medicare UPIN
CADN445AMedicare PIN