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General NPI Number Information
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NPI Number | 1679623862
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Entity Type | Organization
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Legal Business Name | SOUTHWEST EYE CARE INC
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 01/15/2020
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Provider Practice Location Address
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Address Line | 1200 CHASKA CREEK WAY SUITE 110
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City | CHASKA
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State | MN
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Zip | 55318-2525
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Country | US
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Telephone | 952-466-3937
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Fax | 952-466-3936
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Provider Business Mailing Address
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Address Line | 1200 CHASKA CREEK WAY SUITE 110
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City | CHASKA
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State | MN
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Zip | 55318-2525
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Country | US
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Telephone | 952-466-3937
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Fax | 952-466-3936
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. CHRISTOPHER FREED
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Credential | O.D.
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Telephone | 952-466-3937
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 51388
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License Number State | MN
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