Healthcare Provider Details

I. General information

NPI: 1679640221
Provider Name (Legal Business Name): FOR YOUR EYES ONLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CENTRAL AVE
OSSEO MN
55369-1241
US

IV. Provider business mailing address

20 CENTRAL AVE
OSSEO MN
55369-1241
US

V. Phone/Fax

Practice location:
  • Phone: 763-424-1206
  • Fax: 763-424-6838
Mailing address:
  • Phone: 763-424-1206
  • Fax: 763-424-6838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1670
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: ALAN G SCHNEIDER
Title or Position: MANAGER
Credential:
Phone: 763-424-1206