Healthcare Provider Details

I. General information

NPI: 1780694281
Provider Name (Legal Business Name): METROPOLITAN EYE CARE SPECIALITS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 FAXON RD
NORWOOD MN
55368-0359
US

IV. Provider business mailing address

PO BOX 359
NORWOOD MN
55368-0359
US

V. Phone/Fax

Practice location:
  • Phone: 952-467-2250
  • Fax:
Mailing address:
  • Phone: 952-467-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2973000
License Number StateMN

VIII. Authorized Official

Name: GREGORY MACIK
Title or Position: OWNER
Credential:
Phone: 952-467-2250