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General NPI Number Information
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NPI Number | 1467641597
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Entity Type | Organization
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Legal Business Name | REGIONAL EYE SURGERY CENTER INC
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 1455 MONTREAL ST SE
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City | HUTCHINSON
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State | MN
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Zip | 55350-3318
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Country | US
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Telephone | 320-587-6308
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Fax |
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Provider Business Mailing Address
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Address Line | 400 E 10TH ST
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City | WACONIA
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State | MN
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Zip | 55387-4552
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Country | US
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Telephone | 952-442-9770
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | CHRISTOPHER WALLYN
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Credential | MD
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Telephone | 952-442-9770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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