Provider Demographics
NPI:1801025168
Name:MINTO, CORRINNE MICHELLE (DO)
Entity Type:Individual
Prefix:
First Name:CORRINNE
Middle Name:MICHELLE
Last Name:MINTO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11312 WILES RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2113
Mailing Address - Country:US
Mailing Address - Phone:954-510-4777
Mailing Address - Fax:954-510-8777
Practice Address - Street 1:11312 WILES RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-2113
Practice Address - Country:US
Practice Address - Phone:954-510-4777
Practice Address - Fax:954-510-8777
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO 5548156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician