Provider Demographics
NPI:1003545070
Name:MINT VISION PLLC
Entity Type:Organization
Organization Name:MINT VISION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:773-332-0007
Mailing Address - Street 1:2305 63RD ST
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1300
Mailing Address - Country:US
Mailing Address - Phone:630-463-0990
Mailing Address - Fax:630-463-0991
Practice Address - Street 1:2305 63RD ST
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1300
Practice Address - Country:US
Practice Address - Phone:773-332-0007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty