Healthcare Provider Details

I. General information

NPI: 1306899323
Provider Name (Legal Business Name): SOUTHWEST OPHTHALMOLOGY ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S BRUCE ST
MARSHALL MN
56258-1934
US

IV. Provider business mailing address

300 S BRUCE ST
MARSHALL MN
56258-1934
US

V. Phone/Fax

Practice location:
  • Phone: 507-537-1427
  • Fax: 507-537-1742
Mailing address:
  • Phone: 507-537-1427
  • Fax: 507-537-1742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number1009
License Number StateMN

VIII. Authorized Official

Name: DR. THEODORE L FRITSCHE
Title or Position: SOLE PROPRIETOR
Credential: M.D.
Phone: 507-537-1427