Healthcare Provider Details

I. General information

NPI: 1225951379
Provider Name (Legal Business Name): JENNIFER L FAIRBANKS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 2ND AVE N
SAUK RAPIDS MN
56379-1608
US

IV. Provider business mailing address

210 2ND AVE N
SAUK RAPIDS MN
56379-1608
US

V. Phone/Fax

Practice location:
  • Phone: 320-257-4990
  • Fax: 320-257-4991
Mailing address:
  • Phone: 320-257-4990
  • Fax: 320-257-4991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER L FAIRBANKS
Title or Position: OPTOMETRIST/OWNER
Credential: OD
Phone: 320-894-0579