Provider Demographics
NPI:1487840401
Name:MILAN EYE CLINIC
Entity Type:Organization
Organization Name:MILAN EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MINTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:731-686-1647
Mailing Address - Street 1:6032 TELECOM DR
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-3447
Mailing Address - Country:US
Mailing Address - Phone:731-686-1647
Mailing Address - Fax:731-686-1005
Practice Address - Street 1:6032 TELECOM DR
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-3447
Practice Address - Country:US
Practice Address - Phone:731-686-1647
Practice Address - Fax:731-686-1005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1928152W00000X
TN1009152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0075622OtherBLUE CROSS BLUE SHIELD TN
TN3370241Medicaid
TN4085708OtherBLUE CROSS BLUE SHIELD TN
TNCG0087Medicare PIN
TN0075622OtherBLUE CROSS BLUE SHIELD TN
TN4085708OtherBLUE CROSS BLUE SHIELD TN
TNT61300Medicare UPIN