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General NPI Number Information
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NPI Number | 1194377671
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Entity Type | Organization
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Legal Business Name | WALLERICH EYE CARE LLC DBA SWOOP EYE CARE
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Dates
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Enumeration Date | 07/15/2019
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 817 E 66TH ST
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City | RICHFIELD
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State | MN
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Zip | 55423-2506
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Country | US
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Telephone | 612-488-1566
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Fax | 612-488-1564
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Provider Business Mailing Address
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Address Line | 817 E 66TH ST
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City | RICHFIELD
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State | MN
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Zip | 55423-2506
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Country | US
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Telephone | 612-488-1566
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Fax | 612-488-1564
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL THOMAS WALLERICH
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Credential | OD
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Telephone | 124-881-5666
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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 |
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License Number State |
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