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General NPI Number Information
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NPI Number | 1790805976
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Entity Type | Organization
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Legal Business Name | APEX OPTOMETRY RESOURCES LLC
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1605 COUNTY ROAD C W
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City | ROSEVILLE
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State | MN
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Zip | 55113-1302
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Country | US
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Telephone | 651-631-8112
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Fax | 651-631-2113
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Provider Business Mailing Address
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Address Line | 2990 SHERRY CT
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City | LITTLE CANADA
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State | MN
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Zip | 55117-4639
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Country | US
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Telephone | 602-326-2189
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Fax | 651-631-8112
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | MR. ERIC RICHARD TYLER
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Credential | OD, MBA
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Telephone | 651-631-8112
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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 | LD2845
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License Number State | MN
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