Provider Demographics
NPI:1558539221
Name:MARK V MINGRONE OD
Entity Type:Organization
Organization Name:MARK V MINGRONE OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MINGRONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-255-2020
Mailing Address - Street 1:12930 SARATOGA AVE
Mailing Address - Street 2:STE B 2
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-4661
Mailing Address - Country:US
Mailing Address - Phone:408-255-2020
Mailing Address - Fax:
Practice Address - Street 1:12930 SARATOGA AVE.
Practice Address - Street 2:STE. B2
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-4661
Practice Address - Country:US
Practice Address - Phone:408-255-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8284332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0082840Medicare PIN
CAT10670Medicare UPIN
CA0308000001Medicare NSC