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General NPI Number Information
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NPI Number | 1629142278
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Entity Type | Individual
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Provider Name | STEVIN R MINIE O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 8391 TOPANGA CANYON BLVD
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City | CANOGA PARK
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State | CA
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Zip | 91304-2343
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Country | US
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Telephone | 818-363-7828
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Fax |
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Provider Business Mailing Address
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Address Line | 13010 BARTO DR
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City | GRANADA HILLS
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State | CA
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Zip | 91344-1203
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Country | US
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Telephone | 818-363-7828
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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 | 09166T
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License Number State | CA
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