Provider Demographics
NPI:1235229543
Name:MINCEY, JOHN SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SCOTT
Last Name:MINCEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2396 E FRANKLIN BLVD
Mailing Address - Street 2:P.O. BOX 5149
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4727
Mailing Address - Country:US
Mailing Address - Phone:704-864-7878
Mailing Address - Fax:
Practice Address - Street 1:2396 E FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4727
Practice Address - Country:US
Practice Address - Phone:704-864-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-15
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1529152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890901HMedicaid
NC0901HOtherBLUECROSS BLUESHIELD NC
NCU50195Medicare UPIN
NC890901HMedicaid