Provider Demographics
NPI:1952651523
Name:MILLIKEN EYE CARE, LLC
Entity Type:Organization
Organization Name:MILLIKEN EYE CARE, LLC
Other - Org Name:MISS LOU EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:ANDERS
Authorized Official - Last Name:MILLIKEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-443-9876
Mailing Address - Street 1:202 ADVOCATE ROW
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:LA
Mailing Address - Zip Code:71373-3000
Mailing Address - Country:US
Mailing Address - Phone:601-443-9876
Mailing Address - Fax:601-442-4000
Practice Address - Street 1:202 ADVOCATE ROW
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:LA
Practice Address - Zip Code:71373-3000
Practice Address - Country:US
Practice Address - Phone:601-443-9876
Practice Address - Fax:601-442-4000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS792152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09825097Medicaid
MS005352884Medicaid