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General NPI Number Information
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NPI Number | 1922215177
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Entity Type | Organization
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Legal Business Name | FARSTAD INC DBA PEARLE VISION
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2034 FORD PKWY
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City | SAINT PAUL
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State | MN
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Zip | 55116-1931
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Country | US
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Telephone | 651-698-2744
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Fax | 651-698-6918
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Provider Business Mailing Address
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Address Line | 2034 FORD PKWY
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City | SAINT PAUL
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State | MN
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Zip | 55116-1931
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Country | US
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Telephone | 651-698-2744
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Fax | 651-698-6918
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Authorized Official
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Title or Position | MANAGER
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Name | BECKY KERKOW
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Credential |
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Telephone | 651-698-2744
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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 | 2926
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License Number State | MN
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