Healthcare Provider Details

I. General information

NPI: 1952577108
Provider Name (Legal Business Name): NORTH CENTRAL OPHTHALMICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 RUSAN ST
ST CLOUD MN
56303
US

IV. Provider business mailing address

PO BOX 1264 4605 RUSAN ST
ST CLOUD MN
56303
US

V. Phone/Fax

Practice location:
  • Phone: 320-255-9787
  • Fax: 320-255-1046
Mailing address:
  • Phone: 320-255-9787
  • Fax: 320-255-1046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. AL BARROW
Title or Position: GENERAL MANAGER
Credential:
Phone: 320-255-9787