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General NPI Number Information
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NPI Number | 1487706073
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Entity Type | Organization
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Legal Business Name | EDA, INC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 05/04/2009
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Provider Practice Location Address
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Address Line | 5515 XERXES AVE N
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City | BROOKLYN CENTER
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State | MN
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Zip | 55430-2856
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Country | US
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Telephone | 763-560-1636
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Fax | 763-560-4101
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Provider Business Mailing Address
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Address Line | 5515 XERXES AVE N
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City | BROOKLYN CENTER
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State | MN
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Zip | 55430-2856
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Country | US
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Telephone | 763-560-1636
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Fax | 763-560-4101
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Authorized Official
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Title or Position | CFO
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Name | MR. JASON KING
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Credential |
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Telephone | 763-560-1636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 1068294
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License Number State | MN
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