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General NPI Number Information
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NPI Number | 1528456274
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Entity Type | Organization
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Legal Business Name | BYRON EYE CARE
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Dates
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Enumeration Date | 01/05/2015
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Last Update Date | 11/22/2022
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Provider Practice Location Address
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Address Line | 1067 4TH ST NE STE 350
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City | BYRON
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State | MN
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Zip | 55920-5004
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Country | US
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Telephone | 507-775-2001
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Fax | 507-775-0072
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Provider Business Mailing Address
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Address Line | 1067 4TH ST NE STE 350
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City | BYRON
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State | MN
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Zip | 55920-5004
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. WENDY KENNEDY
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Credential | OD
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Telephone | 507-775-2001
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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 | 2995
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License Number State | MN
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