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General NPI Number Information
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NPI Number | 1063064640
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Entity Type | Organization
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Legal Business Name | LIFEVIEW GLAUCOMA CENTER, PC
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Dates
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Enumeration Date | 07/12/2019
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 1702 MILLER TRUNK HWY STE 206
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City | DULUTH
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State | MN
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Zip | 55811-4448
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Country | US
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Telephone | 218-517-5151
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Fax | 217-517-5141
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Provider Business Mailing Address
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Address Line | 1702 MILLER TRUNK HWY STE 206
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City | DULUTH
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State | MN
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Zip | 55811-4448
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Country | US
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Telephone | 218-517-5151
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Fax | 218-517-5141
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Authorized Official
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Title or Position | OPHTHALMOLOGIST
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Name | DR. ELISABETH PETITFOND APONTE
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Credential | MD
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Telephone | 218-517-5151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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