Healthcare Provider Details

I. General information

NPI: 1598067977
Provider Name (Legal Business Name): NORTH STAR EYE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 EDINBOROUGH WAY STE 412
EDINA MN
55435-5923
US

IV. Provider business mailing address

7840 MONTGOMERY RD
CINCINNATI OH
45236-4301
US

V. Phone/Fax

Practice location:
  • Phone: 952-835-3201
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2688
License Number StateMN

VIII. Authorized Official

Name: TERRI ROUSE
Title or Position: DIRECTOR OF MANAGED CARE
Credential:
Phone: 513-354-5827