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General NPI Number Information
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NPI Number | 1407955420
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Entity Type | Organization
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Legal Business Name | TOTAL EYE CARE PA
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 4175 VINEWOOD LN N
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City | PLYMOUTH
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State | MN
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Zip | 55442-2624
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Country | US
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Telephone | 763-553-2883
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Fax | 240-317-5185
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Provider Business Mailing Address
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Address Line | PO BOX 747
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City | HOLLYWOOD
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State | MD
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Zip | 20636-0747
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Country | US
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Telephone | 763-746-2094
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Fax | 240-317-5185
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY BRUCE ANDERSON
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Credential | O.D.
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Telephone | 952-381-7611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2956
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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 |
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License Number State |
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