Healthcare Provider Details

I. General information

NPI: 1215972617
Provider Name (Legal Business Name): RELF EYECARE SPECIALISTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 08/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4413 AIR BASE RD
HERMANTOWN MN
55811-1847
US

IV. Provider business mailing address

4413 AIR BASE RD
HERMANTOWN MN
55811-1847
US

V. Phone/Fax

Practice location:
  • Phone: 218-720-3553
  • Fax: 218-786-9375
Mailing address:
  • Phone: 218-720-3553
  • Fax: 218-786-9375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN J RELF
Title or Position: PRESIDENT
Credential: MD
Phone: 218-720-3553