Provider Demographics
NPI:1962736876
Name:MILAN OPTICAL INC.
Entity type:Organization
Organization Name:MILAN OPTICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAINLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-787-8100
Mailing Address - Street 1:1929 EAST 10TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:IL
Mailing Address - Zip Code:61264
Mailing Address - Country:US
Mailing Address - Phone:309-787-8100
Mailing Address - Fax:
Practice Address - Street 1:1929 EAST 10TH AVENUE
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:IL
Practice Address - Zip Code:61264
Practice Address - Country:US
Practice Address - Phone:309-787-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3961-2384 IBT332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier