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General NPI Number Information
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NPI Number | 1376709097
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Entity Type | Organization
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Legal Business Name | HAWKEYE CLINIC OF HUTCHINSON II, P.C.
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Dates
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Enumeration Date | 08/01/2008
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Last Update Date | 10/09/2013
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Provider Practice Location Address
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Address Line | 225 MAIN ST S.
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City | HUTCHINSON
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State | MN
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Zip | 55350-2508
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Country | US
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Telephone | 320-587-2593
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Fax | 320-587-5852
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Provider Business Mailing Address
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Address Line | PO BOX 187 225 MAIN ST S.
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City | HUTCHINSON
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State | MN
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Zip | 55350-2508
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Country | US
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Telephone | 320-587-2593
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Fax | 320-587-5852
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Authorized Official
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Title or Position | PRESIDENT
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Name | SCOTT A. GLASER
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Credential | O.D.
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Telephone | 320-587-2593
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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 | 2775
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License Number State | MN
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