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General NPI Number Information
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NPI Number | 1225740327
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Entity Type | Individual
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Provider Name | MATTHEW LEPAGE OD
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Gender | Male
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Dates
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Enumeration Date | 12/20/2022
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 401 PHALEN BLVD FL 2
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City | SAINT PAUL
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State | MN
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Zip | 55130-5302
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Country | US
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Telephone | 952-967-7611
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Fax |
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Provider Business Mailing Address
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Address Line | 8170 33RD AVE S # MS 21110Q
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City | MINNEAPOLIS
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State | MN
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Zip | 55425-4516
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Country | US
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Telephone |
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Fax |
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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 | 3829
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License Number State | MN
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