Provider Demographics
NPI:1376927301
Name:MILLS EYE INSTITUTE, INC
Entity Type:Organization
Organization Name:MILLS EYE INSTITUTE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:B
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-322-1000
Mailing Address - Street 1:10685 PROFESSIONAL CIR STE A
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5843
Mailing Address - Country:US
Mailing Address - Phone:775-322-1000
Mailing Address - Fax:775-322-1050
Practice Address - Street 1:600 ASH ST
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-3714
Practice Address - Country:US
Practice Address - Phone:775-322-1000
Practice Address - Fax:775-322-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAO699360261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A699360Medicaid
CACA165174OtherPTAN