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General NPI Number Information
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NPI Number | 1396814539
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Entity Type | Organization
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Legal Business Name | NORTHWAY EYE & CONTACT LENS CENTER
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1545 NORTHWAY DR SUITE 120
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City | SAINT CLOUD
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State | MN
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Zip | 56303-1940
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Country | US
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Telephone | 320-253-2441
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Fax | 320-253-2446
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Provider Business Mailing Address
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Address Line | 1545 NORTHWAY DR SUITE 120
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City | SAINT CLOUD
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State | MN
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Zip | 56303-1940
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Country | US
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Telephone | 320-253-2441
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Fax | 320-253-2446
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | NATALIE MARY GUGGENBERGER
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Credential |
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Telephone | 320-253-2441
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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 | 1776
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2751
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2909
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License Number State | MN
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