Mini John OD PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

6184TG Issued in TX

Legal business name

MINI JOHN OD PLLC

Practice address

2755 Texas Pkwy
Missouri City, TX 77489-5105

Phone

(281) 300-2109

Fax

(713) 995-0548

NPI assigned

Jul 9, 2010

Last updated

Jan 26, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mini John, ODNPI 1215902200

Title

Owner/OD

Phone

(281) 300-2109

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mini John, O.D.

  • Optometrist
  • Missouri City, TX
  • NPI 1215902200
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1278633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327536000000",
    "number": "1043522816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2755 TEXAS PKWY",
            "city": "MISSOURI CITY",
            "state": "TX",
            "postal_code": "774895105",
            "telephone_number": "281-300-2109",
            "fax_number": "713-995-0548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2755 TEXAS PKWY",
            "city": "MISSOURI CITY",
            "state": "TX",
            "postal_code": "774895105",
            "telephone_number": "281-300-2109",
            "fax_number": "713-995-0548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINI JOHN OD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-09",
        "last_updated": "2012-01-26",
        "status": "A",
        "authorized_official_last_name": "JOHN",
        "authorized_official_first_name": "MINI",
        "authorized_official_title_or_position": "OWNER/OD",
        "authorized_official_telephone_number": "281-300-2109",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "6184TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS OPTOMETRY LICENSE",
            "identifier": "6184TG",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Missouri City, TX
• Providers in Missouri City, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.