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General NPI Number Information
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NPI Number | 1154363158
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Entity Type | Individual
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Provider Name | ERIC J THIEM O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2070 EAGLE CREEK LN STE 200
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City | WOODBURY
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State | MN
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Zip | 55129-3217
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Country | US
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Telephone | 651-436-3356
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Fax | 651-436-3394
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Provider Business Mailing Address
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Address Line | W13252 SCANDI ST
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City | RIPON
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State | WI
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Zip | 54971-9548
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Country | US
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Telephone | 920-229-3564
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Fax | 920-734-1642
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2938-035
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG001283
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2932
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License Number State | MN
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