Healthcare Provider Details
I. General information
NPI: 1356498075
Provider Name (Legal Business Name): OCULARRA HOLDING. INC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 01/04/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
570 NORTHTOWN DR NE
BLAINE MN
55434-1043
US
IV. Provider business mailing address
15780 SKYLINE AVE NW
PRIOR LAKE MN
55372-1629
US
V. Phone/Fax
- Phone: 763-784-4081
- Fax: 763-784-0694
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 156FX1800X |
| Taxonomy | Optician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 152W00000X |
| Taxonomy | Optometrist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: MR.
MERLIN
STRAND
JR.
Title or Position: OWNER
Credential:
Phone: 763-784-4081