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General NPI Number Information
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NPI Number | 1750833562
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Entity Type | Organization
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Legal Business Name | FAIRVIEW EXPRESS CARE
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 12/15/2020
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Provider Practice Location Address
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Address Line | 3305 CENTRAL PARK VILLAGE DR SUITE 160
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City | EAGAN
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State | MN
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Zip | 55121-7707
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Country | US
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Telephone | 651-405-5801
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Fax | 651-405-5801
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Provider Business Mailing Address
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Address Line | 2450 RIVERSIDE AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55454-1450
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP REVENUE MANAGEMENT
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Name | ROBERT ANDREW MCCOY
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Credential |
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Telephone | 612-672-6594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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