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General NPI Number Information
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NPI Number | 1073873865
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Entity Type | Individual
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Provider Name | JASON MINTON OD
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Gender | Male
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Dates
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Enumeration Date | 05/25/2012
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 3141 GARDEN RD
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City | BURLINGTON
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State | NC
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Zip | 27215-9786
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Country | US
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Telephone | 704-995-0366
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Fax |
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Provider Business Mailing Address
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Address Line | 1683 MARTIN LUTHER KING JR BLVD
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City | CHAPEL HILL
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State | NC
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Zip | 27514-1604
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Country | US
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Telephone | 704-995-0366
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2314
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License Number State | NC
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