MEDICARE: FAMILY EYECARE PA

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	261Q00000X	Clinic/Center		MN

General Provider Information

NPI Number	:	1518192798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY EYECARE PA

Provider Business Mailing Address
First Line	:	PO BOX 8007
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55108-0007
Country	:	US
Telephone Number	:	651-644-5102
Fax Number	:

Provider Business Practice Location Address
First Line	:	2309 COMO AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55108-1723
Country	:	US
Telephone Number	:	651-644-5102
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID M DALY
Credential	:	O.D.
Telephone Number	:	612-819-3475

Provider Enumeration Date	:	05/18/2009
Last Update Date	:	07/21/2022

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