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General NPI Number Information
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NPI Number | 1740197003
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Entity Type | Individual
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Provider Name | MINDY TILLMAN BCLDO, NCLEC, ABOC
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Gender | Female
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Dates
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Enumeration Date | 08/24/2026
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Last Update Date | 08/24/2026
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Provider Practice Location Address
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Address Line | 1800 NE 12TH AVE
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City | GAINESVILLE
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State | FL
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Zip | 32641-4610
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Country | US
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Telephone | 352-372-3104
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Fax | 352-372-3345
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Provider Business Mailing Address
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Address Line | 1800 NE 12TH AVE
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City | GAINESVILLE
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State | FL
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Zip | 32641-4610
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Country | US
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Telephone | 352-372-3104
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Fax | 352-372-3345
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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 | 156FC0800X
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Taxonomy Name | Contact Lens Technician/Technologist
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 156FC0801X
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Taxonomy Name | Contact Lens Fitter
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License Number | 161396
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | BCLDO5505
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License Number State | FL
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