Healthcare Provider Details

I. General information

NPI: 1881699197
Provider Name (Legal Business Name): ASSOCIATED EYE CARE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 CURVE CREST BLVD W
STILLWATER MN
55082
US

IV. Provider business mailing address

1719 TOWER DR W STE 100
STILLWATER MN
55082-7512
US

V. Phone/Fax

Practice location:
  • Phone: 651-275-3000
  • Fax: 651-275-3032
Mailing address:
  • Phone: 651-275-3000
  • Fax: 651-275-3027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number485
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number485
License Number StateMN

VIII. Authorized Official

Name: GARY S SCHWARTZ
Title or Position: MD/AUTHORIZED OFFICIAL
Credential:
Phone: 651-275-3025