Healthcare Provider Details

I. General information

NPI: 1518959121
Provider Name (Legal Business Name): OPHTHALMOLOGY ASSOCIATES OF MANKATO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 ADAMS ST
MANKATO MN
56001-4801
US

IV. Provider business mailing address

1630 ADAMS ST
MANKATO MN
56001-4801
US

V. Phone/Fax

Practice location:
  • Phone: 507-625-2020
  • Fax: 507-388-9962
Mailing address:
  • Phone: 507-625-2020
  • Fax: 507-388-9962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. MANDI J NELSON
Title or Position: OPTICAL MANAGER
Credential:
Phone: 507-625-2020