Provider Demographics
NPI:1619915105
Name:MINTCHELL, PAULA SUE (OD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:SUE
Last Name:MINTCHELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:SUE
Other - Last Name:MEIRING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1995 SPRINGBROOK SQUARE DR
Mailing Address - Street 2:SUITE111
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5951
Mailing Address - Country:US
Mailing Address - Phone:630-961-0300
Mailing Address - Fax:630-961-0301
Practice Address - Street 1:1995 SPRINGBROOK SQUARE DR
Practice Address - Street 2:SUITE111
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5951
Practice Address - Country:US
Practice Address - Phone:630-961-0300
Practice Address - Fax:630-961-0301
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3712152W00000X
IL046-009355152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20109OtherBCB S OF FLORIDA
FL620782100Medicaid
FLE8739YMedicare PIN
FL620782100Medicaid
ILIL7802001Medicare PIN
FL0539980004Medicare NSC
FLE87392Medicare UPIN