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General NPI Number Information
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NPI Number | 1831197409
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Entity Type | Organization
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Legal Business Name | MAYER OPTICAL SHOP, INC.
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 02/23/2010
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Provider Practice Location Address
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Address Line | 1736 COPE AVE E
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City | MAPLEWOOD
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State | MN
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Zip | 55109-2610
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Country | US
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Telephone | 651-770-2975
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Fax | 651-748-1452
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Provider Business Mailing Address
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Address Line | 1736 COPE AVE E
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City | MAPLEWOOD
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State | MN
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Zip | 55109-2610
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Country | US
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Telephone | 651-770-2975
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Fax | 651-748-1452
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Authorized Official
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Title or Position | OPTICIAN/PRESIDENT
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Name | MR. OTTO P. MAYER JR.
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Credential | OPTICIAN
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Telephone | 651-770-2975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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