Provider Demographics
NPI:1114291952
Name:JANET M. MINT, O.D., PA
Entity Type:Organization
Organization Name:JANET M. MINT, O.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MINT
Authorized Official - Suffix:
Authorized Official - Credentials:OD,
Authorized Official - Phone:904-646-9737
Mailing Address - Street 1:4131 SOUTHSIDE BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-5478
Mailing Address - Country:US
Mailing Address - Phone:904-646-9737
Mailing Address - Fax:904-646-9783
Practice Address - Street 1:4131 SOUTHSIDE BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5478
Practice Address - Country:US
Practice Address - Phone:904-646-9737
Practice Address - Fax:904-646-9783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC001769152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078616100Medicaid
FLGB124AMedicare PIN
FLT84219Medicare UPIN