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General NPI Number Information
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NPI Number | 1073969812
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Entity Type | Organization
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Legal Business Name | EDEN PRAIRIE EYE CARE
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Dates
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Enumeration Date | 05/11/2016
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Last Update Date | 05/11/2016
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Provider Practice Location Address
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Address Line | 8251 FLYING CLOUD DR STE 1296
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-5350
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Country | US
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Telephone | 952-944-2792
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Fax |
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Provider Business Mailing Address
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Address Line | 8251 FLYING CLOUD DR STE 1296
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-5350
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Country | US
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Telephone | 952-944-2792
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DOMINIQUE OKER
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Credential | O.D.
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Telephone | 952-944-2792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1487060265
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License Number State | MN
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