Provider Demographics
NPI:1558740787
Name:MILANI OPTICAL
Entity Type:Organization
Organization Name:MILANI OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN/ PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:KRISTINE
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:530-673-2828
Mailing Address - Street 1:644 PLUMAS ST
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4434
Mailing Address - Country:US
Mailing Address - Phone:530-673-2828
Mailing Address - Fax:530-673-6888
Practice Address - Street 1:644 PLUMAS ST
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4434
Practice Address - Country:US
Practice Address - Phone:530-673-2828
Practice Address - Fax:530-673-6888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD7041332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA04011OtherMEDICAL EYE SERVICES