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General NPI Number Information
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NPI Number | 1740309640
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Entity Type | Organization
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Legal Business Name | CRYSTAL VIEW EYE CARE
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 07/16/2008
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Provider Practice Location Address
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Address Line | 102 W HUMPHREY ST
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City | LAKE CRYSTAL
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State | MN
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Zip | 56055-0158
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Country | US
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Telephone | 507-726-6639
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Fax | 507-726-6382
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Provider Business Mailing Address
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Address Line | PO BOX 158 102 W HUMPHREY ST
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City | LAKE CRYSTAL
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State | MN
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Zip | 56055-0158
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Country | US
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Telephone | 507-726-6639
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Fax | 507-726-6382
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Authorized Official
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Title or Position | OWNER--OPTOMETRIST
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Name | JUDITH K. SWEZEY
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Credential | O.D.
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Telephone | 507-726-6639
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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 | 2215
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 2215
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License Number State | MN
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