Healthcare Provider Details

I. General information

NPI: 1144343252
Provider Name (Legal Business Name): SOUTHWEST EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 GREELEY AVE N # 3
GLENCOE MN
55336-2135
US

IV. Provider business mailing address

1464 WHITE OAK DR
CHASKA MN
55318-2525
US

V. Phone/Fax

Practice location:
  • Phone: 320-864-2020
  • Fax: 320-864-6684
Mailing address:
  • Phone: 952-466-3937
  • Fax: 952-466-3936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2627
License Number StateMN

VIII. Authorized Official

Name: MS. KRISTI LEANN NARUM
Title or Position: BUSINESS MANAGER
Credential:
Phone: 952-466-3937