Healthcare Provider Details

I. General information

NPI: 1093703415
Provider Name (Legal Business Name): ERIC SCOTT BAILEY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 E 7TH ST
MONTICELLO MN
55362-4666
US

IV. Provider business mailing address

2416 MEADOW DR
BUFFALO MN
55313-2424
US

V. Phone/Fax

Practice location:
  • Phone: 763-295-5600
  • Fax: 888-785-9518
Mailing address:
  • Phone: 320-250-6254
  • Fax: 888-785-9518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2232
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: