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General NPI Number Information
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NPI Number | 1497859813
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Entity Type | Organization
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Legal Business Name | OPTOMETRY 2000 VISION CARE, INC
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Dates
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Enumeration Date | 09/08/2006
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Last Update Date | 04/22/2010
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Provider Practice Location Address
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Address Line | 203 E MAIN ST STE B
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City | MELROSE
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State | MN
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Zip | 56352-1485
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Country | US
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Telephone | 320-256-4000
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Fax | 320-256-4002
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Provider Business Mailing Address
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Address Line | 203 E MAIN ST STE B
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City | MELROSE
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State | MN
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Zip | 56352-1485
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Country | US
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Telephone | 320-256-4000
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Fax | 320-256-4002
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. RICKY FRANCIS GROETSCH
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Credential | O.D.
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Telephone | 320-256-4000
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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 | MN2082
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License Number State | MN
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