Healthcare Provider Details

I. General information

NPI: 1598750952
Provider Name (Legal Business Name): MARY J FEMRITE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 5TH AVE S SUITE 110
COLD SPRING MN
56320-2343
US

IV. Provider business mailing address

308 5TH AVE S SUITE 110
COLD SPRING MN
56320-2343
US

V. Phone/Fax

Practice location:
  • Phone: 320-685-5400
  • Fax: 320-685-3506
Mailing address:
  • Phone: 320-685-5400
  • Fax: 320-685-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2773
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: