=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356524540
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAIRVIEW EXPRESS CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2007
-----------------------------------------------------
Last Update Date | 02/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13819 HANSON BLVD NW
-----------------------------------------------------
City | ANDOVER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55304-7608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-572-5700
-----------------------------------------------------
Fax | 763-392-4052
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1700 UNIVERSITY AVE W
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55104-3727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-672-6740
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SYS DIR GOVT REIMB & NETWK REL
-----------------------------------------------------
Name | MAUREEN V RING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 612-672-6740
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------