Provider Demographics
NPI:1255432720
Name:MILICI, MICHAEL WILLIAM (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:MILICI
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:3812 LIBERTY HWY
Mailing Address - Street 2:SUITE #1
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1344
Mailing Address - Country:US
Mailing Address - Phone:864-225-0474
Mailing Address - Fax:864-225-0547
Practice Address - Street 1:3812 LIBERTY HWY
Practice Address - Street 2:SUITE #1
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1344
Practice Address - Country:US
Practice Address - Phone:864-225-0474
Practice Address - Fax:864-225-0547
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-01-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC935152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU109860281Medicare UPIN