Provider Demographics
NPI:1295715761
Name:MCMINN, RONNIE M (OD)
Entity type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:M
Last Name:MCMINN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 131
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72145-0131
Mailing Address - Country:US
Mailing Address - Phone:501-268-5808
Mailing Address - Fax:501-305-3370
Practice Address - Street 1:101 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-5421
Practice Address - Country:US
Practice Address - Phone:501-268-5808
Practice Address - Fax:501-305-3370
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2126152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5137700001OtherDMER
AR1487757738OtherMCMINN EYECARE CENTER NPI
AR5137700001OtherDMER
AR1487757738OtherMCMINN EYECARE CENTER NPI