Healthcare Provider Details

I. General information

NPI: 1477624971
Provider Name (Legal Business Name): EYE FASHIONS OPTICAL SHOPPE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 NW 1ST AVE
GRAND RAPIDS MN
55744
US

IV. Provider business mailing address

202 NW 1ST AVE
GRAND RAPIDS MN
55744
US

V. Phone/Fax

Practice location:
  • Phone: 218-326-0358
  • Fax: 218-999-0067
Mailing address:
  • Phone: 218-326-0358
  • Fax: 218-326-0566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2415
License Number StateMN

VIII. Authorized Official

Name: DR. LARRY JAMES SCHLAUDERAFF
Title or Position: OWNER OPTOMETRIST
Credential: OD
Phone: 218-326-0358