Provider Demographics
NPI:1952326829
Name:JUSTIN S. MCMINN, O.D.,P.A.
Entity Type:Organization
Organization Name:JUSTIN S. MCMINN, O.D.,P.A.
Other - Org Name:MCMINN EYE CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCMINN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:501-982-0032
Mailing Address - Street 1:2650 JOHN HARDEN DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-1886
Mailing Address - Country:US
Mailing Address - Phone:501-982-0032
Mailing Address - Fax:501-982-0121
Practice Address - Street 1:2650 JOHN HARDEN DR
Practice Address - Street 2:SUITE D
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-1886
Practice Address - Country:US
Practice Address - Phone:501-982-0032
Practice Address - Fax:501-982-0121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2526152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR155018722Medicaid
AR5F131Medicare PIN
AR155018722Medicaid
AR5513500001Medicare NSC