Provider Demographics
NPI:1538152616
Name:MCMINN, JUSTIN S (OD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:S
Last Name:MCMINN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:101 N MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-5421
Mailing Address - Country:US
Mailing Address - Phone:501-982-0032
Mailing Address - Fax:501-982-0121
Practice Address - Street 1:2650 JOHN HARDEN DR
Practice Address - Street 2:SUITE D
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-1886
Practice Address - Country:US
Practice Address - Phone:501-982-0032
Practice Address - Fax:501-982-0121
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AR2526152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148119722Medicaid
AR1487757738OtherMCMINN EYE CARE CENTER
AR148119722Medicaid
AR5513500001Medicare NSC
AR49820Medicare PIN