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General NPI Number Information
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NPI Number | 1730203597
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Entity Type | Organization
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Legal Business Name | OPTOMETRIC EYE CARE CENTERS, PA
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 1965 11TH AVE E SUITE 101
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City | MAPLEWOOD
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State | MN
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Zip | 55109-5167
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Country | US
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Telephone | 651-777-3555
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Fax | 651-777-4459
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Provider Business Mailing Address
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Address Line | 1965 11TH AVE E SUITE 101
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City | MAPLEWOOD
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State | MN
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Zip | 55109-5167
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Country | US
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Telephone | 651-777-3555
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Fax | 651-777-4459
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GREGORY W KRAUPA
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Credential | OD
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Telephone | 651-777-3555
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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 | 1635
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License Number State | MN
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