MEDICARE: LIFEVIEW GLAUCOMA CENTER, PC

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
1	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1063064640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFEVIEW GLAUCOMA CENTER, PC

Provider Business Mailing Address
First Line	:	1702 MILLER TRUNK HWY STE 206
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55811-4448
Country	:	US
Telephone Number	:	218-517-5151
Fax Number	:	218-517-5141

Provider Business Practice Location Address
First Line	:	1702 MILLER TRUNK HWY STE 206
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55811-4448
Country	:	US
Telephone Number	:	218-517-5151
Fax Number	:	217-517-5141

Authorized Official
Title or Position	:	OPHTHALMOLOGIST
Name	:	DR. ELISABETH PETITFOND APONTE
Credential	:	MD
Telephone Number	:	218-517-5151

Provider Enumeration Date	:	07/12/2019
Last Update Date	:	09/09/2024

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