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General NPI Number Information
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NPI Number | 1760636286
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Entity Type | Organization
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Legal Business Name | NICOLLET VISION CARE OPTOMETRISTS P.A.
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Dates
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Enumeration Date | 11/11/2008
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Last Update Date | 11/11/2008
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Provider Practice Location Address
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Address Line | 3142 HENNEPIN AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-2619
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Country | US
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Telephone | 612-822-7021
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Fax | 612-822-6123
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Provider Business Mailing Address
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Address Line | 3142 HENNEPIN AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-2619
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Country | US
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Telephone | 612-822-7021
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Fax | 612-822-6123
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Authorized Official
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Title or Position | OWNER
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Name | DR. LINDA MARIE CHOUS
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Credential | O.D.
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Telephone | 612-822-7021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 2219
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License Number State | MN
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