Healthcare Provider Details

I. General information

NPI: 1316677925
Provider Name (Legal Business Name): SYDNEY ATHMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYDNEY ATHMANN

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 TROOP DR
SARTELL MN
56377-4582
US

IV. Provider business mailing address

2180 TROOP DR
SARTELL MN
56377-4582
US

V. Phone/Fax

Practice location:
  • Phone: 320-258-3915
  • Fax: 320-258-3917
Mailing address:
  • Phone: 320-258-3915
  • Fax: 320-258-3917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3803
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: