Healthcare Provider Details

I. General information

NPI: 1558539221
Provider Name (Legal Business Name): MARK V MINGRONE OD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12930 SARATOGA AVE. STE. B2
SARATOGA CA
95070-4661
US

IV. Provider business mailing address

12930 SARATOGA AVE STE B 2
SARATOGA CA
95070-4661
US

V. Phone/Fax

Practice location:
  • Phone: 408-255-2020
  • Fax:
Mailing address:
  • Phone: 408-255-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number8284
License Number StateCA

VIII. Authorized Official

Name: MARK MINGRONE
Title or Position: OWNER
Credential:
Phone: 408-255-2020