=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477690709
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES HARRY MINESINGER O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 260 S LAWRENCE BLVD SUITE 101
-----------------------------------------------------
City | KEYSTONE HEIGHTS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32656-9217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-473-2600
-----------------------------------------------------
Fax | 532-473-2633
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 260 S LAWRENCE BLVD SUITE 101
-----------------------------------------------------
City | KEYSTONE HEIGHTS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32656-9217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-473-2600
-----------------------------------------------------
Fax | 532-473-2633
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPC994
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------