Norman Jay Mintz, O.D.

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

License

6087T Issued in CA

Practice address

825 Gravenstein Hwy N
Ste 7
Sebastopol, CA 95472-2844

Phone

(707) 823-9141

Fax

(707) 823-5148

NPI assigned

Dec 4, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233014400000",
    "number": "1609934785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 GRAVENSTEIN HWY N",
            "address_2": "STE 7",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954722844",
            "telephone_number": "707-823-9141",
            "fax_number": "707-823-5148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 GRAVENSTEIN HWY N",
            "address_2": "STE 7",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954722844",
            "telephone_number": "707-823-9141",
            "fax_number": "707-823-5148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINTZ",
        "first_name": "NORMAN",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-04",
        "last_updated": "2009-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "6087T",
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "CA",
            "license": "6087T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0060870",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine Ann Miller, FNP-C
• Marlys Miller, RRT
• Michelle Anne Miller, LCSW
• Trevor Ross Miller, D.C.
• Roberta Latefa Mineo, PHD
• Asieh Moghaddam
• Conor Michael Moldowan, RPH
• Audrey Molony-Benjamin, CMT
• Michelle Montalbano
• Ji He Moon

• Corneal and Contact Management Optometrist in Sebastopol, CA
• Providers in Sebastopol, CA by specialty
• Corneal and Contact Management Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.