=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023628591
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAHUL FARMAH OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2020
-----------------------------------------------------
Last Update Date | 08/08/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 680 HWY 10 NE
-----------------------------------------------------
City | BLAINE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-785-2200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 1ST AVE SW APT 212
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55902-3374
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 647-785-8031
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 3696
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------