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General NPI Number Information
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NPI Number | 1184606949
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Entity Type | Organization
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Legal Business Name | RUNESTONE EYE CARE, INC.
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 03/22/2011
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Provider Practice Location Address
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Address Line | 3015 HIGHWAY 29 S SUITE 4155
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City | ALEXANDRIA
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State | MN
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Zip | 56308-3486
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Country | US
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Telephone | 320-759-1130
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Fax |
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Provider Business Mailing Address
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Address Line | 3015 HIGHWAY 29 S SUITE 4155
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City | ALEXANDRIA
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State | MN
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Zip | 56308-3486
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Country | US
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Telephone | 320-759-1130
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL WILLIAM WYSOSKI
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Credential | O.D.
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Telephone | 320-759-1130
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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 | 2383
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License Number State | MN
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