MEDICARE: DR. STEVIN R MINIE O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	09166T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629142278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVIN R MINIE O.D.

Provider Business Mailing Address
First Line	:	13010 BARTO DR
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-1203
Country	:	US
Telephone Number	:	818-363-7828
Fax Number	:

Provider Business Practice Location Address
First Line	:	8391 TOPANGA CANYON BLVD
Second Line	:
City	:	CANOGA PARK
State	:	CA
Zip	:	91304-2343
Country	:	US
Telephone Number	:	818-363-7828
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/09/2007

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