Active NPI
Mindy Tillman, BCLDO, NCLEC, ABOC
- Optician
- Gainesville, FL
National Provider Identifier
1740197003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- BCLDO5505
- Practice address
- 1800 NE 12TH Ave
Gainesville, FL 32641-4610 - Phone
- (352) 372-3104
- Fax
- (352) 372-3345
- NPI assigned
- Aug 24, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contact Lens Technician/Technologist | 156FC0800X | FL | ||
| Contact Lens Fitter | 156FC0801X | 161396 | FL | |
| Optician | 156FX1800X | BCLDO5505 | FL | Primary |
Addresses
Primary practice location
1800 NE 12TH Ave
Gainesville, FL 32641-4610
Mailing address
1800 NE 12TH Ave
Gainesville, FL 32641-4610
Phone (352) 372-3104
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1787529600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787529600000",
"number": "1740197003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 NE 12TH AVE",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326414610",
"telephone_number": "352-372-3104",
"fax_number": "352-372-3345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 NE 12TH AVE",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326414610",
"telephone_number": "352-372-3104",
"fax_number": "352-372-3345"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TILLMAN",
"first_name": "MINDY",
"credential": "BCLDO, NCLEC, ABOC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-08-24",
"last_updated": "2026-08-24",
"certification_date": "2026-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "156FC0800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Contact Lens",
"state": "FL",
"license": null,
"primary": false
},
{
"code": "156FC0801X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Contact Lens Fitter",
"state": "FL",
"license": "161396",
"primary": false
},
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "FL",
"license": "BCLDO5505",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.