Healthcare Provider Details

I. General information

NPI: 1154352979
Provider Name (Legal Business Name): EYE SURGEONS & PHYSICIANS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 DOCTORS PARK
SAINT CLOUD MN
56303
US

IV. Provider business mailing address

109 DOCTORS PARK
SAINT CLOUD MN
56303
US

V. Phone/Fax

Practice location:
  • Phone: 320-253-3637
  • Fax: 320-253-5412
Mailing address:
  • Phone: 320-253-3637
  • Fax: 320-253-5412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS M HOBDAY
Title or Position: ADMINISTRATOR
Credential:
Phone: 320-253-3637