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NPI Code Detail

MEDICARE: MEGAN MARIE SIS OD, MS, FAAO

MEDICARE: MEGAN MARIE SIS OD, MS, FAAO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristOEG002668PA
2152WV0400XVision Therapy Optometrist3315MN
3152W00000XOptometrist3315MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13315OTHERMNLICENSE
2OEG002668OTHERPALICENSE

General Provider Information

NPI Number : 1013242197
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEGAN MARIE SIS OD, MS, FAAO
Provider Business Mailing Address
First Line : 12170 ABERDEEN ST NE
Second Line :
City : BLAINE
State : MN
Zip : 55449-4716
Country : US
Telephone Number : 763-757-7000
Fax Number : 763-757-3328
Provider Business Practice Location Address
First Line : 12170 ABERDEEN ST NE
Second Line :
City : BLAINE
State : MN
Zip : 55449-4716
Country : US
Telephone Number : 763-757-7000
Fax Number : 763-757-3328
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2009
Last Update Date : 07/11/2019

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