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General NPI Number Information
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NPI Number | 1578780433
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Entity Type | Organization
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Legal Business Name | UNION OPTICAL, INC.
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 2002 LONDON RD
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City | DULUTH
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State | MN
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Zip | 55812-2144
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Country | US
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Telephone | 218-728-2863
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Fax | 218-728-2863
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Provider Business Mailing Address
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Address Line | 2002 LONDON RD
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City | DULUTH
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State | MN
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Zip | 55812-2144
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Country | US
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Telephone | 218-728-2863
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Fax | 218-728-2863
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. KIMBERLY LOUISE BUJOLD
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Credential |
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Telephone | 218-728-2863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 5227365
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License Number State | MN
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