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General NPI Number Information
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NPI Number | 1437250164
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Entity Type | Organization
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Legal Business Name | SPECNIQUE BY STEPHANIE THIER OD PC
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 05/14/2015
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Provider Practice Location Address
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Address Line | 1607 MCMILLAN ST
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City | WORTHINGTON
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State | MN
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Zip | 56187-2802
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Country | US
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Telephone | 507-727-3937
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Fax | 507-727-3939
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Provider Business Mailing Address
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Address Line | 1607 MCMILLAN ST
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City | WORTHINGTON
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State | MN
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Zip | 56187-2802
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Country | US
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Telephone | 507-727-3937
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Fax | 507-727-3939
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | STEPHANIE THIER
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Credential | OD
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Telephone | 507-360-0298
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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 | 595
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License Number State | SD
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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 | 601
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License Number State | SD
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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 | 594
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License Number State | SD
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