Provider Demographics
NPI:1568557981
Name:MINT, RAYMOND JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:JOSEPH
Last Name:MINT
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 1:293 MAIN ST
Mailing Address - Street 2:PO BOX 297
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-1615
Mailing Address - Country:US
Mailing Address - Phone:607-687-3391
Mailing Address - Fax:607-687-4226
Practice Address - Street 1:293 MAIN ST
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-1615
Practice Address - Country:US
Practice Address - Phone:607-687-3391
Practice Address - Fax:607-687-4226
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007227152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U64512Medicare UPIN