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General NPI Number Information
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NPI Number | 1306923461
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Entity Type | Organization
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Legal Business Name | EYEWEAR SPECIALISTS INC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 06/16/2016
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Provider Practice Location Address
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Address Line | 14050 NICOLLET AVE SUITE 101
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City | BURNSVILLE
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State | MN
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Zip | 55337-5710
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Country | US
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Telephone | 952-898-6223
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Fax | 952-898-8832
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Provider Business Mailing Address
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Address Line | 7450 FRANCE AVE S SUITE 100
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City | EDINA
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State | MN
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Zip | 55435-4787
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Country | US
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Telephone | 952-832-8120
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Fax | 952-832-8124
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Authorized Official
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Title or Position | RCM MANAGER
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Name | MS. CHERYL MAYNE
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Credential |
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Telephone | 952-832-8100
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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 | 4699580
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License Number State | MN
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