Provider Demographics
NPI:1821153396
Name:MINIX EYE CLINIC, INC.
Entity Type:Organization
Organization Name:MINIX EYE CLINIC, INC.
Other - Org Name:MINIX ONE HOUR OPTICAL, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:S
Authorized Official - Last Name:MINIX
Authorized Official - Suffix:SR
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:606-789-2020
Mailing Address - Street 1:327 MAYO PLAZA
Mailing Address - Street 2:BOX 1687
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240
Mailing Address - Country:US
Mailing Address - Phone:606-789-2020
Mailing Address - Fax:606-789-2019
Practice Address - Street 1:327 MAYO PLAZA
Practice Address - Street 2:BOX 1687
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240
Practice Address - Country:US
Practice Address - Phone:606-789-2020
Practice Address - Fax:606-789-2019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0407156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY52904075Medicaid
KY180014427OtherRAILROAD MEDICARE
KY01155Medicare PIN
KYT54521Medicare UPIN
KYG68549Medicare UPIN
KY0377360001Medicare PIN