Provider Demographics
NPI:1043292048
Name:MINNICH, DARREN L (OD)
Entity type:Individual
Prefix:DR
First Name:DARREN
Middle Name:L
Last Name:MINNICH
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 1:1752 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:NAPPANEE
Mailing Address - State:IN
Mailing Address - Zip Code:46550-9216
Mailing Address - Country:US
Mailing Address - Phone:574-773-4341
Mailing Address - Fax:574-773-2324
Practice Address - Street 1:1752 E MARKET ST
Practice Address - Street 2:
Practice Address - City:NAPPANEE
Practice Address - State:IN
Practice Address - Zip Code:46550-9216
Practice Address - Country:US
Practice Address - Phone:574-773-4341
Practice Address - Fax:574-773-2324
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2013-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002832A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200095640Medicaid
INU63560Medicare UPIN
IN200095640Medicaid
IN4771280001Medicare NSC