Healthcare Provider Details

I. General information

NPI: 1700714706
Provider Name (Legal Business Name): TELEOPTOMETRIC SERVICE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 COUNTY ROAD 120
SAINT CLOUD MN
56303-4872
US

IV. Provider business mailing address

5 DAKOTA DR STE 307
NEW HYDE PARK NY
11042-1106
US

V. Phone/Fax

Practice location:
  • Phone: 380-223-3412
  • Fax:
Mailing address:
  • Phone: 380-223-3412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SUSAN L CHRISTOPHER-BRAND
Title or Position: MANAGER
Credential:
Phone: 703-314-8795