Provider Demographics
NPI:1841262755
Name:MILANO, JON G (OD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:G
Last Name:MILANO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 CENTRAL AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-1847
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 CENTRAL AVE
Practice Address - Street 2:SUITE D
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-1847
Practice Address - Country:US
Practice Address - Phone:256-832-2252
Practice Address - Fax:256-832-2254
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS904TA468152W00000X
GAGAOPT-001696152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009971095Medicaid
AL51524860OtherBLUE CROSS BLUE SHIELD
ALU80797Medicare UPIN
AL51524860OtherBLUE CROSS BLUE SHIELD