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General NPI Number Information
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NPI Number | 1689600900
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Entity Type | Organization
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Legal Business Name | FAMILY EYE CLINIC & CONTACT LENS CENTER
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 07/01/2024
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Provider Practice Location Address
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Address Line | 3822 WEST OLD SHAKOPEE ROAD
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City | BLOOMINGTON
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State | MN
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Zip | 55431-3538
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Country | US
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Telephone | 952-884-4366
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Fax | 952-884-4809
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Provider Business Mailing Address
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Address Line | 3822 WEST OLD SHAKOPEE RD
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City | BLOOMINGTON
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State | MN
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Zip | 55431-3538
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Country | US
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Telephone | 952-884-4366
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Fax | 952-884-4809
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Authorized Official
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Title or Position | BILLER
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Name | GLORIA REESE
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Credential |
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Telephone | 952-934-6926
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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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