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General NPI Number Information
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NPI Number | 1275725277
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Entity Type | Organization
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Legal Business Name | FAMILY VISION CLINIC OF FARMINGTON
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 08/14/2007
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Provider Practice Location Address
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Address Line | 19650 PILOT KNOB ROAD
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City | FARMINGTON
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State | MN
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Zip | 55024
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Country | US
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Telephone | 952-895-5434
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Fax | 952-895-5464
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Provider Business Mailing Address
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Address Line | PO BOX 252
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City | FARMINGTON
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State | MN
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Zip | 55024-0252
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Country | US
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Telephone | 952-895-5434
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Fax | 952-895-5464
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. STEFANIE ANN HURST
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Credential | O.D.
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Telephone | 952-895-5434
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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 | 2777
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License Number State | MN
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