Provider Demographics
NPI:1215289558
Name:PAULA S. MINTCHELL,O.D., P.C.
Entity type:Organization
Organization Name:PAULA S. MINTCHELL,O.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MINTCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-961-0300
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46-009355152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL7802Medicare PIN