Provider Demographics
NPI:1588966618
Name:MILANAK FAMILY VISION CENTER, L.L.C.
Entity type:Organization
Organization Name:MILANAK FAMILY VISION CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:MILANAK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-201-2423
Mailing Address - Street 1:6031 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-1001
Mailing Address - Country:US
Mailing Address - Phone:814-201-2423
Mailing Address - Fax:814-201-2444
Practice Address - Street 1:6031 6TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-1001
Practice Address - Country:US
Practice Address - Phone:814-201-2423
Practice Address - Fax:814-201-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000688152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011519680005Medicaid
PA0011519680005Medicaid