Provider Demographics
NPI:1285898064
Name:MINIX ONE HOUR OPTICAL
Entity type:Organization
Organization Name:MINIX ONE HOUR OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:S
Authorized Official - Last Name:MINIX
Authorized Official - Suffix:
Authorized Official - Credentials:DO
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 1:212 GLENVIEW PLAZA
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653
Practice Address - Country:US
Practice Address - Phone:606-789-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77900702Medicaid
KY0377360001Medicare NSC