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General NPI Number Information
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NPI Number | 1598067977
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Entity Type | Organization
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Legal Business Name | NORTH STAR EYE ASSOCIATES
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Dates
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Enumeration Date | 11/17/2010
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Last Update Date | 11/17/2010
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Provider Practice Location Address
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Address Line | 3300 EDINBOROUGH WAY STE 412
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City | EDINA
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State | MN
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Zip | 55435-5923
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Country | US
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Telephone | 952-835-3201
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Fax |
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Provider Business Mailing Address
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Address Line | 7840 MONTGOMERY RD
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City | CINCINNATI
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State | OH
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Zip | 45236-4301
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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 | DIRECTOR OF MANAGED CARE
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Name | TERRI ROUSE
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Credential |
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Telephone | 513-354-5827
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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 | 2688
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License Number State | MN
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