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General NPI Number Information
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NPI Number | 1609013895
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Entity Type | Organization
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Legal Business Name | DAGENAIS EYE SERVICES, INC
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Dates
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Enumeration Date | 01/09/2009
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Last Update Date | 01/09/2009
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Provider Practice Location Address
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Address Line | 2510 MAPLE GROVE RD SUITE 500
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City | DULUTH
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State | MN
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Zip | 55811-1864
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Country | US
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Telephone | 218-740-3000
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Fax | 715-398-0104
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Provider Business Mailing Address
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Address Line | 2510 MAPLE GROVE RD SUITE 500
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City | DULUTH
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State | MN
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Zip | 55811-1864
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Country | US
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Telephone | 218-740-3000
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Fax | 715-398-0104
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | VERNE DAGENAIS
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Credential | O.D.
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Telephone | 218-740-3000
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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 | 2760
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License Number State | MN
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