Provider Demographics
NPI:1295848455
Name:MINTEER, JOHN FREDERICK (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FREDERICK
Last Name:MINTEER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:FREDERICK
Other - Last Name:MINTEER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:129 WILTON RD
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1749
Mailing Address - Country:US
Mailing Address - Phone:603-924-9591
Mailing Address - Fax:603-924-9593
Practice Address - Street 1:129 WILTON RD
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1749
Practice Address - Country:US
Practice Address - Phone:603-924-9591
Practice Address - Fax:603-924-9593
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH 282152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80587783Medicaid
NHNH7783Medicare ID - Type Unspecified
NH4956720001Medicare NSC
NHT25685Medicare UPIN