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General NPI Number Information
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NPI Number | 1326591603
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Entity Type | Organization
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Legal Business Name | EYE CLINIC NORTH, PROFESSIONAL ASSOCIATION
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Dates
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Enumeration Date | 08/03/2016
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Last Update Date | 08/03/2016
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Provider Practice Location Address
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Address Line | 2016 1ST AVE
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City | HIBBING
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State | MN
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Zip | 55746-1728
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Country | US
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Telephone | 218-263-3633
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Fax | 218-263-3634
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Provider Business Mailing Address
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Address Line | 413 CHESTNUT ST
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City | VIRGINIA
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State | MN
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Zip | 55792-2525
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Country | US
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Telephone | 218-741-5886
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Fax | 218-741-5894
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW JOHN SIPOLA
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Credential | O.D.
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Telephone | 218-741-5886
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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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