1598850893 NPI number — MINTZ FAMILY OPTOMETRY, APC

Table of content: (NPI 1598850893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598850893 NPI number — MINTZ FAMILY OPTOMETRY, APC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MINTZ FAMILY OPTOMETRY, APC
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:
6
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:
1598850893
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
553 NORTH MOUNTAIN AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91786-5016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-985-2876
Provider Business Mailing Address Fax Number:
909-946-8585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
553 NORTH MOUNTAIN AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91786-5016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-985-2876
Provider Business Practice Location Address Fax Number:
909-946-8585
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MINTZ
Authorized Official First Name:
DENA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
909-985-2876

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4109T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 5933T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 8810T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: OPT8810TPA , 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)

  • Identifier: 1871584581 . This is a "NPI FOR INDIVIDUAL RUBIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 45941 . This is a "ID FOR SAFEGUARD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 9V12145 . This is a "IEHP ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1417948092 . This is a "NPI INDIVIDUAL FOR MINTZ" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 16110 . This is a "RUBIN ID FOR MES VISION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 35021 . This is a "GVA ID NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 12993 . This is a "ID FOR VBA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 3163 . This is a "MINTZ ID FOR MES VISION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 49103 . This is a "ID FOR SAFEGUARD PPO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: SD0041091 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09160 . This is a "SPECTERA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 211537 . This is a "EYMED ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 091303 . This is a "DELTA VISION ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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