Healthcare Provider Details

I. General information

NPI: 1346322609
Provider Name (Legal Business Name): MANKATO OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MADISON AVE SUITE 338
MANKATO MN
56001
US

IV. Provider business mailing address

1400 MADISON AVE SUITE 338
MANKATO MN
56001
US

V. Phone/Fax

Practice location:
  • Phone: 507-387-6695
  • Fax: 507-387-6696
Mailing address:
  • Phone: 507-387-6695
  • Fax: 507-387-6696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE L GIESLER
Title or Position: CFO
Credential:
Phone: 507-387-6695