1598850893 NPI number — MINTZ FAMILY OPTOMETRY, APC

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 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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