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NPI Code Detail

MEDICARE: DR. SHIROLA & ASSOCIATES, OPTOMETRISTS P.A.

MEDICARE: DR. SHIROLA & ASSOCIATES, OPTOMETRISTS P.A.
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
1152W00000XOptometrist2160MN

General Provider Information

NPI Number : 1487926333
Entity Type Code : Organization
Provider Name (Legal Business Name) : DR. SHIROLA & ASSOCIATES, OPTOMETRISTS P.A.
Provider Business Mailing Address
First Line : 11673 PONDVIEW CT
Second Line :
City : CHAMPLIN
State : MN
Zip : 55316-2629
Country : US
Telephone Number : 763-422-9209
Fax Number :
Provider Business Practice Location Address
First Line : 950 11TH ST SW
Second Line :
City : PINE CITY
State : MN
Zip : 55063-2113
Country : US
Telephone Number : 320-629-7465
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. STEPHEN SHIROLA
Credential : O.D.
Telephone Number : 763-422-9209
Provider Enumeration Date : 02/07/2012
Last Update Date : 02/22/2012

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