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General NPI Number Information
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NPI Number | 1598850893
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Entity Type | Organization
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Legal Business Name | MINTZ FAMILY OPTOMETRY, APC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 09/24/2010
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Provider Practice Location Address
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Address Line | 553 NORTH MOUNTAIN AVENUE
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City | UPLAND
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State | CA
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Zip | 91786-5016
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Country | US
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Telephone | 909-985-2876
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Fax | 909-946-8585
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Provider Business Mailing Address
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Address Line | 553 NORTH MOUNTAIN AVENUE
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City | UPLAND
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State | CA
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Zip | 91786-5016
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Country | US
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Telephone | 909-985-2876
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Fax | 909-946-8585
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Authorized Official
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Title or Position | PRESIDENT
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Name | DENA M. MINTZ
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Credential | OD
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Telephone | 909-985-2876
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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 | 4109T
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5933T
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 8810T
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT8810TPA
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License Number State | CA
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