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General NPI Number Information
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NPI Number | 1356450969
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Entity Type | Organization
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Legal Business Name | ADVANCED OPTOMETRY, P.A.
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 17799 KENWOOD TRL
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City | LAKEVILLE
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State | MN
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Zip | 55044-9493
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Country | US
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Telephone | 952-898-4088
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Fax | 952-898-0883
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Provider Business Mailing Address
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Address Line | 17799 KENWOOD TRL
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City | LAKEVILLE
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State | MN
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Zip | 55044-9493
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Country | US
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Telephone | 952-898-4088
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Fax | 950-898-0883
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Authorized Official
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Title or Position | DR./OPTOMETRIST
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Name | DR. AMY M RUDSER
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Credential | O.D.
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Telephone | 952-898-4088
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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 | LD 3031000
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License Number State | MN
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