Healthcare Provider Details

I. General information

NPI: 1376145151
Provider Name (Legal Business Name): OWL OPTICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4318 UPTON AVE S
MINNEAPOLIS MN
55410-1555
US

IV. Provider business mailing address

4318 UPTON AVE S
MINNEAPOLIS MN
55410-1555
US

V. Phone/Fax

Practice location:
  • Phone: 612-367-4106
  • Fax:
Mailing address:
  • Phone: 612-367-4106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER ALLEN HANSEN
Title or Position: OWNER
Credential:
Phone: 612-978-9871