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General NPI Number Information
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NPI Number | 1346291630
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Entity Type | Organization
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Legal Business Name | DOFFIN FAMILY EYE CARE PA
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 09/25/2017
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Provider Practice Location Address
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Address Line | 4750 WASHINGTON SQ
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-3257
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Country | US
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Telephone | 651-429-3379
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Fax | 651-429-8681
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Provider Business Mailing Address
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Address Line | 4750 WASHINGTON SQ
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-3257
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Country | US
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Telephone | 651-429-3379
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Fax | 651-429-8681
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Authorized Official
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Title or Position | INSURANCE MANAGER
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Name | JULIE OLUFSON
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Credential |
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Telephone | 651-429-3379
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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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