Healthcare Provider Details

I. General information

NPI: 1831173335
Provider Name (Legal Business Name): ROCHESTER FAMILY EYE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 11TH AVE NW
ROCHESTER MN
55901-4276
US

IV. Provider business mailing address

3630 11TH AVE NW
ROCHESTER MN
55901-4276
US

V. Phone/Fax

Practice location:
  • Phone: 507-288-2457
  • Fax: 507-288-1299
Mailing address:
  • Phone: 507-288-2457
  • Fax: 507-288-1299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MR. TERRANCE DUANE DOWNS
Title or Position: PRACTICE MGR
Credential:
Phone: 507-288-2467