Healthcare Provider Details

I. General information

NPI: 1780806372
Provider Name (Legal Business Name): EYE SURGEONS & PHYSICIANS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 DOCTORS PARK
ST CLOUD MN
56303
US

IV. Provider business mailing address

109 DOCTORS PARK
ST CLOUD MN
56303
US

V. Phone/Fax

Practice location:
  • Phone: 320-253-1404
  • Fax: 320-253-5412
Mailing address:
  • Phone: 320-253-1404
  • Fax: 320-253-5412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHAEL DONALD EICHLER
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 320-253-3637