Provider Demographics
NPI:1508108408
Name:MINIX EYE CARE PSC
Entity type:Organization
Organization Name:MINIX EYE CARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:S
Authorized Official - Last Name:MINIX
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:606-789-2020
Mailing Address - Street 1:PO BOX 1687
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-5687
Mailing Address - Country:US
Mailing Address - Phone:606-789-2020
Mailing Address - Fax:
Practice Address - Street 1:1018 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1410
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:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0407156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty