Healthcare Provider Details

I. General information

NPI: 1114554045
Provider Name (Legal Business Name): SYDNI KAYE DAVIS FARHAT OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYDNI KAYE DAVIS

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 ZANE AVE N
MINNEAPOLIS MN
55443-1400
US

IV. Provider business mailing address

10000 ZANE AVE N
MINNEAPOLIS MN
55443-1400
US

V. Phone/Fax

Practice location:
  • Phone: 763-528-6999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2020014779
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number002432
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4042
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: