Healthcare Provider Details

I. General information

NPI: 1790228294
Provider Name (Legal Business Name): EYE ASSOCIATES OF CENTRAL MINNESOTA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2016
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 ROOSEVELT RD SUITE 101
SAINT CLOUD MN
56301-4867
US

IV. Provider business mailing address

628 ROOSEVELT RD SUITE 101
SAINT CLOUD MN
56301-4867
US

V. Phone/Fax

Practice location:
  • Phone: 320-774-3789
  • Fax: 320-774-3483
Mailing address:
  • Phone: 320-774-3789
  • Fax: 320-774-3483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JULIE OLMSCHEID
Title or Position: OFFICE MANAGER
Credential:
Phone: 320-774-3789