1053713552 NPI number — PHILIP R. MILL, OD AND MICHAEL D. SUTTON, OD INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053713552 NPI number — PHILIP R. MILL, OD AND MICHAEL D. SUTTON, OD INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHILIP R. MILL, OD AND MICHAEL D. SUTTON, OD INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053713552
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3715 RAILROAD AVE STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURG
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94565-5236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-432-6484
Provider Business Mailing Address Fax Number:
925-432-3878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3715 RAILROAD AVE STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURG
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94565-5236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-432-6484
Provider Business Practice Location Address Fax Number:
925-432-3878
Provider Enumeration Date:
09/16/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SUTTON
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
925-432-6484

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  13917 TPL , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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