Provider Demographics
NPI:1730450941
Name:DR. MICHAEL MILICI & ASSOCIATES L.L.C.
Entity type:Organization
Organization Name:DR. MICHAEL MILICI & ASSOCIATES L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MILICI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:864-225-0474
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC935152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU109860281Medicare UPIN