Healthcare Provider Details

I. General information

NPI: 1427046267
Provider Name (Legal Business Name): ST CLOUD OPTICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 15TH ST N
SAINT CLOUD MN
56303-1747
US

IV. Provider business mailing address

2055 15TH ST N
SAINT CLOUD MN
56303-1747
US

V. Phone/Fax

Practice location:
  • Phone: 320-253-5628
  • Fax: 320-251-7122
Mailing address:
  • Phone: 320-253-5628
  • Fax: 320-251-7122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DEE STARKEY
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 320-251-1432