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General NPI Number Information
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NPI Number | 1306899323
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Entity Type | Organization
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Legal Business Name | SOUTHWEST OPHTHALMOLOGY ASSOCIATES, P.A.
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 04/02/2008
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Provider Practice Location Address
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Address Line | 300 S BRUCE ST
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City | MARSHALL
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State | MN
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Zip | 56258-1934
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Country | US
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Telephone | 507-537-1427
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Fax | 507-537-1742
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Provider Business Mailing Address
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Address Line | 300 S BRUCE ST
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City | MARSHALL
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State | MN
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Zip | 56258-1934
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Country | US
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Telephone | 507-537-1427
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Fax | 507-537-1742
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. THEODORE L FRITSCHE
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Credential | M.D.
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Telephone | 507-537-1427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 1009
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License Number State | MN
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