Healthcare Provider Details

I. General information

NPI: 1720173651
Provider Name (Legal Business Name): ST PAUL EYE CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 WOODWINDS DR SUITE 110
WOODBURY MN
55125-2523
US

IV. Provider business mailing address

2080 WOODWINDS DR SUITE 110
WOODBURY MN
55125-2523
US

V. Phone/Fax

Practice location:
  • Phone: 651-738-6800
  • Fax: 651-714-6997
Mailing address:
  • Phone: 651-738-6800
  • Fax: 651-714-6997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS J. RICE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 651-738-6800